r/emergencymedicine • u/thickiecheeks • Jun 11 '25
Advice RN to MD
Hey all, looking for some advice and fielding a few personal anecdotes if anyone is willing to share. I've been working as an RN in a busy ER in a mid sized city for awhile now, and I love the environment. I'm getting the itch to go back to school (always knew I would), and I'm really considering pursuing my MD. I have a nursing degree and a bio degree, and I'm definitely not afraid of an academic challenge.
I've been considering my NP for awhile, but have had some serious encouragement from family/friends to go for my MD instead. So, I'm asking as someone who already loves the EM environment:
Do you regret becoming an ER doc? What was the experience of residency truly like? Did you feel well prepped by residency to be independent as staff? If you had to do it all again with the knowledge you have now, would you? And if you work with NPs, do you personally feel they support your position and add significantly to patient care?
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u/precordial-thump-45 ED Attending Jun 11 '25
I know plenty of people that did med school in their 30s and even a few in their 40s.
Great quote from Earl Nightingale: “Never give up on a dream just because of the time it will take to accomplish it. The time will pass anyway.”
Many reasons to argue for either MD or NP route. You’ll (hopefully) be 50 one day either way, where do you want to be then and what route will best get you there?
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u/Broguest_Squadron ED Attending Jun 11 '25
I believe I was put on this earth to practice emergency medicine, however, you can't really practice emergency medicine in this country anymore. I'm either getting yelled at for using evidence based medicine instead of just CTing everything, being used as an after hours clinic by PCPs and specialists, or trying to explain to a patient that I'm a specialist in emergency conditions and not their 10 year chronic complaint.
Love the shift work of it but if I could do it all over again I'd go into anesthesia. Building an exit ramp from this dying specialty currently.
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u/bikelifer Jun 15 '25
What's your exit ramp lol? Room for friends?
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u/Broguest_Squadron ED Attending Jun 16 '25
Precision medicine/longevity/sport performance practice, aligns more with more interests these days and lets me be my own boss.
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u/Practical_Sound ED Attending Jun 11 '25
Former ED RN, went to medical school at 36. To say I have absolutely zero regrets would be dishonest, but it's been an overall net positive and I'm glad I made the choice that I did.
Yes, I feel well prepared by residency. I also did a one year fellowship due to some particular career goals, but I would have been ready for general practice after residency.
I do work with NPs. Some understand the flow, and I can trust them to know their limitations. On the other hand, with some I have seen some very concerning choices. Very honestly, I could not imagine practicing emergency medicine with less education than I have.
Years ago I also initially struggled with picking apart NP/PA vs going to medical school, but once I'd made the decision I knew it was the right one.
If you want to talk any specifics about my own experience I'm more than happy to talk in PMs. Good luck to you!
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u/Top_System7120 Jun 11 '25
My favorite ER docs have been RN to MD. Some of my worst experiences in medicine have been the RN to NP unfortunately. If you want to take care of someone it should be with a thoughtful approach to learning. Its a brutal process to finish a MD, but it is something that sounds like you have good reasons to go through.
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u/thickiecheeks Jun 11 '25
A huge reason why I considered NP so strongly is because I do truly love nursing, and I think the pt-provider connection offered by nursing is legitimately unique and meaningful. I appreciate you sharing your experience, and it’s wonderful to know that some RN to MDs are able to provide such meaningful pt care. I guess the key here is that my pt interactions are defined by my own independent practice, and less to do with my title itself
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u/jilll_sandwich Jun 11 '25
There are concerns regarding the education required for NP vs the scope of their practice. Some doctors see this as dangerous, have a look at the r/Noctor subreddit. Not saying everything there reflects the truth, but personally for me some of the posts confirmed my choice of pursuing MD vs NP.
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u/everythingwright34 Jun 11 '25
Eh, I’d be very careful suggesting that subreddit. It’s a massive cesspool. If you want actual opinions of physicians about midlevels specifically NPs I wouldn’t look to a place that hates midlevels to begin with lol
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u/jilll_sandwich Jun 11 '25
I did think it was all hate when I started reading there, then I found some posts interesting. Having a scope larger then my education should allow, that would leave me more prone to make mistakes and miss things, scared me. Perhaps it was misguided. Please suggest a different place for me to read then :)
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u/the_silent_redditor Jun 11 '25
Thankfully, most of the NPs I work with are great at my current shop.
There are a few that definitely have the ‘pull the ladder up’ phenomenon, and immediately shit on nursing colleagues despite having little actual clinical experience.
I worked in the UK a long time ago, and the NPs used to refer to themselves as ‘the consultants of the unit’. They were fucking insufferable and also awful at their job and so incredibly mean to junior medical staff, especially to nurses.
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u/everythingwright34 Jun 11 '25
Time matters. If you have all the time in the world and the situation is right (Financials, family, proper education needed to go into med school) then go to Med school.
And this is no knock on NPs but with a bio degree, I would encourage a PA route since you wouldn't need to get extra classes in order to go to PA school vs NP school. The schooling for PA school would most likely make you feel better prepared after you graduated in comparison. And like I said, no knock on NPs, this is just my opinion from what I've seen in a fresh NP vs a fresh PA.
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u/Proof-Inevitable5946 ED Attending Jun 11 '25
I did it, totally worth it IMO.
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u/thickiecheeks Jun 11 '25
You started as an RN? Did you initially work as a nurse in an EM environment?
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u/Smart-As-Duck ED Pharmacist Jun 11 '25
You’re young and single.
If I had both of those, I would go to medical school in a heartbeat. From the way you describe your situation, you have everything going for you to give yourself an opportunity to do it.
It’s better to aim high and if that doesn’t work then pursue NP/PA. If you’re going to be 37 at some point anyway, you might as well be a doctor and be 37.
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u/Howdthecatdothat ED Attending Jun 11 '25
I finished residency at 40. I LOVE my job. I loved the journey to get here. I love learning as much as I can about medicine. It is a huge sacfrice, and if you are working in the ED you already know the downsides. I say go for it lest you find yourself in your 50s wondering "what if" for the rest of your life.
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u/putachee Jun 11 '25
I did my RN and worked in the ED for almost 4 years. Applied to med school during this time but was never successful in Canada. Applied overseas and got in immediately. 7 years later (4 yrs med, 2 yrs family med residency, and 1 yr emergency fellowship) and I'm about to be EM staff next month. Started med school at 26. Best decision of my life. As much as I loved nursing, I always wanted more autonomy and more responsibility. However, having my nursing background has been an incredible help throughout my training thus far. I made incredible memories and met amazing people (including my now wife). Would highly recommend pursuing medicine. As difficult as it was, I wouldn't change it for the world, and it really was worth it.
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u/thickiecheeks Jun 11 '25
This sounds very similar to my situation, and I would ideally be starting med school at 28 (so not much older). I'm Canadian myself and would plan to apply primarily to local schools. Do you mind sharing where you pursued your education?
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u/Ornery-Reindeer5887 Jun 11 '25
How old are you and what’s your family situation / financial situation? If you’re young (under 30) and have really thought about it then probably a good idea. If you’re older or have family or financial needs NP may be a better/ more feasible route. It’ll be a literal 10 years from now before you become an attending
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u/thickiecheeks Jun 11 '25
I’m single and 27, and have been saving to go back to school for some time now. I do have family that lives near one of the schools I would apply to and could move home if required. I think one of the biggest barriers for me is the reality of NP being 3ish years to practice versus MD being 8-10
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u/jinkazetsukai Jun 11 '25
As a 31 year old M2 (CC/F/CP Paramedic/RN/MLS) who had the itch for more knowledge and didn't wanna be under a thumb or have to bite my thumb at anyone go MD/DO. If you get that itch now and feel like you should know more, understand more, be able to think deeper: it's going to cone back. Better to finish residency at 36 than finish NP and wish you were 3 years into med school anyway.
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u/Davidhaslhof ED Resident Jun 11 '25
I’m in the same boat as you my friend. Worked as a medic who became an RT, then did flight for 9 years. Went back to medical school at 34 and am now starting my first year of EM residency. I’m much happier I decided to go to medical school rather than PA school.
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u/jinkazetsukai Jun 12 '25
Strong work 💪. You'll never regret pushing yourself beyond what barriers you set for yourself. PA and NP should be a definitive not a consideration.
For anyone reading if you're considering APP vs physician then go MD/DO do family or internal med and take APP providers as students or as their authorizing physician. Regardless of the rhetoric you can switch jobs as a physician. There are plenty of anesthesiologists working in ED, surgeons working in ED, ED docs working in derm, etc.
Physicians have unlimited practice you can legally do whatever you want. Should is another argument, but you also shouldn't go from being a derm NP for 10 years to just immediately being a cardiology one..... CAN you? Yes......should tho.....
If you wanna know more I can pipe in I guess but as someone who has been the direct assistant for a physician recruiter I see it all the time where a physician who is boarded in a specialty gets a job in another.
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u/thickiecheeks Jun 11 '25
Thank you for your advice! Did you feel satisfied with your education progression? Or have you continued to feel like you need to ‘always know more’? I do a lot of my own research about underlying patho/treatment course for novel pt presentations, and I feel like I’m always hungry for more information
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u/jinkazetsukai Jun 11 '25
I did up until I got into MD. Now I feel fulfilled and satisfied, knowing in going to be the highest trained I can be in order to take care of my patients and also physicians don't know everything, but damn sure they have the basic prerequisite knowledge to find out and build on in order to understand it. So I can ACTUALLY do my own research and come to a definitive factual answer, and if I have an idea I can theorize it and put it into practice and even study and maybe one day I'll invent a new technique product or treatment out of it.
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u/thickiecheeks Jun 11 '25
That sense of self-reliance and capacity to enact change sounds like an absolute privilege. Love to hear that you have that level of satisfaction
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u/jinkazetsukai Jun 12 '25
Also, if you don't want the self reliance physicians can work under each other too.
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u/Catswagger11 RN Jun 11 '25
I manage a MICU and these last few years I’m seeing a lot of IM residents come through that are older than you would be during residency. Over the last two months I’ve seen a late 30s intern and low 40s R2. The R2 was married with kids. I wouldn’t let age play too much of a role in your decision.
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u/zidbutt21 Jun 11 '25
I just turned 30, but a couple of my best friends from med school started when they were your age or even older. Also did an away rotation with med students who used to be nurses. The time is worth it if you’re ok with taking loans or are fortunate enough to pay for a chunk of your tuition without loans.
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u/Mundane-Bee2725 Jun 15 '25
The knowledge difference between the NP/PA and MD/DO is vast. Don't short change yourself because of an extra 3-4 years training. In the end it's worth doing the few extra years of training. I started med school at 39... will finish residency at 46. You have plenty of time.
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u/Worldd Jun 11 '25
Yeah dude, do NP. The MD-NP relationship is pretty rough, partially because of the education disparity, but also partially because of the amount of work a lot of physicians had to do that NPs get to skip.
The only reason to do MD over NP right now is based on autonomy or principles, and the autonomy reasoning is withering away.
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u/EbolaPatientZero Jun 11 '25
You’re looking at being 36 minimum by the time you finish residency. Imo its not worth it. Just become a CRNA or a PA and have greater flexibility
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u/FriedChickenIsTrash2 Physician Assistant Jun 11 '25
He'd only be 36. Now if he lived in 3000 BC where the average life expectancy was 37 then I'd agree with you, waste of time. But now that we've got a handle on consumption and plagues, people are living long enough that becoming a doctor at 36 is worthwhile
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u/Ornery-Reindeer5887 Jun 11 '25
Says the guy who didn’t go through med school and residency
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u/FriedChickenIsTrash2 Physician Assistant Jun 11 '25
I don't think you need to go through med school and residency to say that we've got a handle on consumption and plagues nowadays
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u/bleach_tastes_bad Jun 11 '25
yeah i mean i think someone that never went through med school or residency saying “don’t do what i did, go the other route” is pretty convincing actually
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u/Forward-Razzmatazz33 Jun 12 '25
I was over 40 when I finished residency. OP will have multiple millions of dollars in greater earning potential.
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u/-ThreeHeadedMonkey- Jun 11 '25
Female or male?
Coz it's harder for women as those hormones will eventually start panicking
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u/Relentless-Dragonfly Jun 11 '25
I just love women being reduced to “panicking hormones” on medical sub. Makes my day
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u/-ThreeHeadedMonkey- Jun 11 '25
I meant no disrespect but it's not something that should be ignored.
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u/Ok-Sympathy-4516 RN Jun 12 '25
Exactly what hormones will be panicking? What are they panicking about? The disco?
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u/thickiecheeks Jun 12 '25
I’m female and my hormones have panicked more at the thought of not achieving my full career potential than at the thought of not having the chance to grow a human (not all of us dream of being mothers, but that dream is amazing as well)
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u/ashishkabob Jun 11 '25
Depends on your goals. If you’re 27, you’re young enough that MD is still a very valid choice. But if you’re looking to start a family at some point, that’ll almost assuredly mean finding someone, dating, getting married, and having kids while you’re in med school and residency when you frankly don’t have much free time. Doable but stressful. Then the additional 5 years of training will also be 5 years of lost earning potential on top of hundreds of thousands in loans. MD will probably be the financially better choice in the long run but you won’t surpass where you’d be otherwise until you’re in your mid 40s, maybe even 50.
Then there’s the question of how long you think you’ll stick with it. If you think ER for life and you won’t burnout, then sure go for it. But if not, NP gives you lateral flexibility. And burnout as an NP might be less than as an MD since your work life will also look different with likely a smaller patient load, less critical patients, and not being responsible for all the major procedures like central lines, LPs, intubations, etc.
MD is the longer road, harder, more stressful. But in the long run, probably better financially (unless you did med spa type stuff. I know lots of NPs who make more than me). And if it’s about the education and training, it’s a no brainer. But don’t underestimate how much med school alone will age you. You’ll come out on the other side qualified and competent but it’ll take its toll getting there. And failure isn’t an option when you have loans. Just be VERY sure about your choice before making it. That being said, if it were me, I’d go for it.
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u/thickiecheeks Jun 11 '25
Thank you for your answer - I definitely can appreciate the value of having work/life balance, and the impact of med school and residency on mental health. Those were the deciding factors when I chose not to pursue med school when I was in my early 20s. I have never had a huge drive to have kids, so that's a non-issue as well. These comparisons definitely make the decision a little less challenging
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u/mcvmccarty ED Attending Jun 11 '25
I started med school age 33. I think it was worth it, but I wasn’t already in a gainful career. It’s more stress and more time, but it’s the only way to become captain of the team.
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u/Ergophobic Jun 12 '25
I was an ED RN who worked for four years in a busy mid-sized shop. I considered either air ambulance flight nursing vs going the NP route, but opted instead to go to med school. I knew I would always wonder "what if" as others have said, so I pulled the trigger and went for my MD. I was one of the older guys there (having now been on my third career path....) but it was completely fine. I'm now an ED attending back at my original ED and love (almost) every minute of it. Zero regrets! If you want it, do it!
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u/Eldorren ED Attending Jun 12 '25
Yes, I regret becoming an ER doc. No, I don't regret becoming a physician. That being said, the natural path from RN would be to pursue your NP. Great pay, quicker path and LOTS more flexibility. MD will be a long road and huge sacrifice. 4 years med school and 3-4 years residency. That's going to be a decade of your life lost and more than likely an enormous expense.
You mentioned that you would starting at 28 and aren't interested in kids, etc.. You might be very surprised at how you feel about life at 38 compared to 28.
My wife is an NP. She used to work in the ER and now she works as a PCP and makes half my salary. That's huge flexibility. In EM, you are pretty much locked in for life. NP can afford you tremendous career flexibility.
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u/Entire-Oil9595 Jun 11 '25
Do it. I got no problem with the APP route But if your guts are telling you that you need to be the person in the room calling the shots, ya gotta go MD/DO.
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u/latinoflame Jun 11 '25
If what you really want is a new academic challenge, maybe look for a fellowship that would allow you to pivot to something like policy-making, education, simulation or administration. A good RN is incredibly valuable to the ED team and we need more now than ever.
That being said, if you're dead set on changing your role to MD/NP, I think you really need to look at your life and financial situation first and foremost. Going 200-300k+ into debt in your late 20s/early 30s is not for everyone, especially at the time most people are starting to save for their first home or starting a family (or both). Also, you are setting aside at minimum the next 8-10 years just to your education and training and making very little if any money. Add another 5-10 years of paying off debt to that.
EM Residency does prepare you well to work most places, but at the cost of some of your sanity and self-respect. You really need to lean on your support network or it will completely consume you.
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u/steak_blues Jun 11 '25
It’s not a matter of if you could earn an MD and make it through residency, it’s a question of are you willing to? You’re looking at setting aside the next 7 years minimum of your personal life to fully dedicate to being a learner in a very full time manner (really it’s the work of 2 full time jobs). There’s certainly time for play and relaxation, but it’s small moments, not a time for big breaks. You’ll be pushing aside travel plans, personal events, family events. If you really are going for it, you could expect a good likelihood of needing to pick up and move somewhere entirely new where you don’t have social support and therefore need to build social circle from scratch. And then again with residency.
In the midst of it, there are really hard moments in both medical school and residency. To me, the hardest bit was not actually the tests (though boards are a challenge), material, clinical etc. it’s the endurance that was required of you and the “no looking back” financial reality of taking on 100K++ of student debt which pretty much commits you to the path. Would I do it again? Absolutely. It’s a great job, intellectually satisfying, eventually wonderful financial security, and you fulfill an actual moral purpose. But ngl that I went into it blind not really understanding the magnitude of what you give up to do this “job”.
NP route would be an easy detour to gain a bit more autonomy and pivot your role to more that “decision maker”. MD is really a lifelong commitment to pursuing your own personal limit of excellence.
27 is not at all too late to start. You just have to really do some self reflection to understand and decide if MD is worth the sacrifices. I would give the same advice to a 19 and 35 year old.
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u/catatsrophy Jun 11 '25
I am also 27, ED RN, considering the MD path and also have a bio degree if you want to connect :)
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u/Prettyhighforaflyguy RN Jun 12 '25
ER RN currently in my 2nd year of med school, feel free to ask me any questions
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u/woahwoahvicky Jun 12 '25
Being an NP will never scratch the itch of knowing the full depth of pathophys of the diseases you encounter. An MD will know everything from medical management to the kind of chemical bonds and reactions that cause formation of metabolic products.
Get the MD.
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u/jjasonjames Jun 13 '25
Second-person story. I went to med school with a lady who had been an RN for several years and became an NP. She realized that being an NP wasn’t right for her and felt that she did not have the authority and enough knowledge to do everything she wanted. She realized that becoming a physician would limit her somewhat into a speciality category, but it didn’t phase her. She didn’t score the best in the class, about middle, but she became a successful doc and is respected. That being said, she told us that the curriculum was unexpected in terms of “brutality.” So, I wouldn’t expect that it will be an easy thing, but the hard work was certainly worth it for her. If you’re a great student naturally, then you should do great.
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u/LeopardVegetable2334 Jun 13 '25
I did this exact transition and am finishing up residency. It is definitely a long haul but I have had no regrets along the way. The knowledge base of MD/DO v NP is wildly different in breadth.
If you have the thoughts definitely do it or you will always ask what if.
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u/Used_spaghetti Jun 13 '25
I'm an NP and I've been thinking about going to med school though my physician colleagues keep talking me out of it. The upside of being an NP is if you get tired of EM or any other specialty you couldn't jump ship to another one. Physicians can't do that without doing another residency.
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u/Mundane-Bee2725 Jun 15 '25
Go for it! In the end, it's totally worth it. Residency is the hardest thing I've ever done, but i would choose to do it again over being a mid level provider. In 10 years, you can still be in the ED working as a nurse or as a physician, which would you rather be doing?
It's wild how much nicer patients are to you as a physician vs. a nurse!
I'm happy to answer any questions about what the transition is like. Just send me a dm.
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u/harveyjarvis69 RN Jun 18 '25
I don’t have advice but some of my favorite er docs of all time…were nurses.
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u/EstablishmentGood494 Jun 11 '25
DO NOT GO NP! THERE ARE NO STANDARDS AND IT'S A FAKE DEGREE.
Either go MD or PA.
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u/Beenanabread25 Jun 12 '25
I’m a nurse and my husband is a physician. Nursing and medicine are very different, not only in levels of education but overall responsibility in patient care and outcomes. We have very different purposes and are taught to think differently from each other in our schooling and practice (not that there’s no overlap - but nursing is far more about practical application of clinical skills with some medical knowledge and medicine is far more about leading and guiding medical care with comprehensive medical knowledge and expertise with some practical clinical skills). Nursing is a vocation, medicine is a profession. Both are extremely respectable directions, with benefits and challenges.
Personally, I would never become an NP or ever recommend someone do so. I’ve seen more NPs come close to harming or killing patients due to lack of training and knowledge than I care to recount. I have too much respect for nursing and medicine to straddle the line or train halfway. Either be the best nurse you can be or go on to train as a physician, but I repeat - NP is not the way.
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u/Grump_NP Jun 11 '25
If MD is feasible for you I would go the MD route. I’m a former ER nurse turned NP. I actually enjoy my work as a NP, but if I could go back in time and tell my younger self something it would have been to go to med school. I’m at a stage of my life now where my career is not the focus of my life, so I’m not gonna go back now. If you are a career oriented person and that’s your passion I would 100% go for it. The only reason I would recommend NP over MD/DO would be if the other things in your life are your focus and you don’t want the time sink.
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u/MaximsDecimsMeridius Jun 11 '25
The NPs i have worked with are largely independent tbh. And at my old place, can do any procedure the attending could, this this level of independence varies significantly between shops. I've seen places where NPs in the ER only saw urgent care type visits.
One thing you can do as a midlevel that you can't do as an MD/DO is change specialties and practice settings easily. I'd think about how much independence you want and how much flexibility you may want as you get older.
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u/thickiecheeks Jun 11 '25
This is a significant barrier to me, as I would like to start working in EM considering how much I absolutely LOVE the environment. However, the long term goal is to provide education to others and work in sexual/reproductive health
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u/MaximsDecimsMeridius Jun 11 '25
I mean there's plenty of obgyn issues in the ER, but that sounds more like an obgyn or infertility clinic which you almost definitely wouldn't work in as an ER attending but could transition to as a midlevel. Also do you really, and I mean really, want to do 4 years of school and 3 to 4 years of grueling residency (5 for obgyn)?
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u/EbolaPatientZero Jun 11 '25
Your not gonna be doing any sexual/reproductive health anything in EM
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u/MaximsDecimsMeridius Jun 11 '25
Us 1st tri ob and std testing is basically the extent of my reproductive health practice in the ER lol.
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u/slimmaslam Jun 11 '25
NP intubation 🙈
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u/bgarza18 Jun 11 '25
Intubation isn’t a special skill, it’s a fairly common one.
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u/Forward-Razzmatazz33 Jun 12 '25
Where I trained, the ICU was staffed with NPs at night. Each and every one of them was very proficient with thousands of intubations. CRNAs intubate all day long. There is an argument against NP practice creep, but this ain't it.
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u/AdministrativeFox784 Jun 11 '25
If you’re asking for financial advice it’s probably NP if you invest your money appropriately and are able to continue working in some capacity while pursuing your Masters or DNP and also factoring in a significantly reduced tuition vs med school. You may come out ahead as an MD towards the end of your career but it will take decades. If it’s your dream then just do it though.
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u/jsmall0210 Jun 11 '25
If you need to do it, you should do it. If you go the NP route you might always ask yourself “wat if”. Finishing by 36 or 37 isn’t bad at all