Help me become Ob-Wan Gynobi.

June 8, 2008 4:30 PM

I don’t know whether to be an doctor or go into an allied health field, like physician’s assistant or nurse-practitioner. I want to be in-between Dr. Quinn Medicine Woman and the guy who gets his door knocked on by the gangster late at night and then takes the bullets out on his kitchen table: a healthcare provider who serves a community and is able to really make connections with people. More inside...

You guys have provided such incredible advice in the past for people in similar positions and I humbly request a bit of it for myself. I don’t know whether to be an doctor or go into an allied health field, like physician’s assistant or nurse-practitioner.

My cred: I have a pretty diverse professional background: classic protocol research over a summer in the Bronx, working in a women’s health center doing counseling on sexual/reproductive health, and training as an EMT and a doula, being a personal healthcare assistant for a woman with severe chronic fatigue syndrome. I just graduated from Wesleyan a couple weeks ago with a GPA of 3.53, with that classic American “upward trend” leading to all As my senior year. I truly feel like whatever I want to do, I have at least a workable shot.

From here, I have the option of enrolling in a post-baccalaureate program for MD or a second-degree nursing program. What I really love is working with people; I know that no matter what I’d do, I’d want to have a lot of direct patient contact. My interests are in women’s health; ideally, I’d be working in family care or as an ob/gyn catchin' babies.

What draws me to MD is the scope of care and the privilege that seems like it would allow me to get access to places that nurses can’t; if I’m doing a lot of activism or working in non-profit, which I plan to be, I know that MD after my name will help out with the squares. This is especially pertinent with regards to obstretrics: I know that midwife model of care vs. doctor model of care is in a deathlock right now, and I am nervous that I wouldn't be able to make MD into "Midwife in Disguise" (c Ina May Gaskin) the way I want to. What draws me to nursing is the more clinical/holistic style of training and the ability to “hang out” with people more. Salary requirements are very low on my list.

I don’t know whether to be an MD or a nurse-practitioner, and I don’t know a lot of either and they inevitably argue for their own professional choices. So here’s my question: what do you think?

And (shot in the dark) is there a profession of people who would help guide and package me for a health career like they have for HS students going into undergraduate?

Thanks for reading. I hope the above was thorough nuff and I'm happy to answer any other questions.

posted by damsorrow to Education (9 answers total)

Go for the MD, and do it now (when you're young). It's a more useful, more respected degree that will open more doors for you than the mid-level clinician degrees. I work with many of both types of folks, and the doctors almost always have a bit of extra access to the cooler opportunities. Part of this is that it's easier for the docs to create their own opportunities. The mid-levels are more often at the mercy of the docs.
posted by OmieWise at 4:48 PM on June 8, 2008

You say that salary requirements are low on your list, but you need to take in to account the debt load you'll be facing after graduation. There may be many advantages to being a doctor over a nurse, but they may be outweighed by having to take a high paying but unsatisfying job instead of doing what you really want. I've never looked into health-care school debt forgiveness programs, I'm sure they exist but I bet they are limited in scope and utility.

That said, I think you can do more in more situations as a doctor as long as you are free to do what you want and not stuck paying back the feds for 10 years (on top of the 7 or so years you spend in med school).
posted by ChrisHartley at 4:56 PM on June 8, 2008

Go for the gusto, become a doctor. This shouldn't deter you, but malpractice costs and insurance are astronomical for OB/GYNs.
posted by LoriFLA at 5:06 PM on June 8, 2008

this isn't an easy question to answer at all. I am a doctor and can tell you that the sheepskin is helpful to open doors in our society and around the world, but you could derive enormous satisfaction from pursuing a career as well as a NP or a PA or a midwife. Certainly if midwifery is in your blood, you would have a long tough education that would try its best in most settings to beat that notion out of you and would leave you scarred perhaps.
posted by dougiedd at 5:50 PM on June 8, 2008

This is purely anecdotal, but I have two friends who are doctors and who are quite unhappy with their work -- lots of debt, so they feel constrained, and jobs where they see each patient for maybe 10 minutes, lots of paperwork, etc. (I also know some doctors who are totally happy, but their situations are similar -- minimal patient time, etc -- they are just happy with those conditions.) And I know a bunch of nurses who hate the low status of the job (they are not nurse practitioners, who I think are usually treated better), but love that they are in hot demand, they can set their hours, pick and choose where to work, have lots and lots of contact with patients, and so on -- they genuinely feel that they are making differences in people's lives.

A long time ago, I used to work with a nurse practitioner who had a specialty in public health (maybe a MPH too, I don't know), and her job seemed incredibly cool to me. And right now I know two people with nursing degrees who are doing health outreach and intervention, which has a lot more "community" focus than most medical work -- a lot of medical work is more like being an auto technician, rather than being an engineer; not all medical jobs give much a "big picture" sense of things.
posted by Forktine at 6:38 PM on June 8, 2008

Way back when, my wife applied to the Yale Nurse-Midwifery Program, which is supposed to be excellent. (She didn't get in, and ended up doing other things.) You might want to talk to them, as well as med schools with strong programs in ob/gyn, to get some feel for what your schooling and subsequent career would be like as either a nurse/midwife or physician.

I was surprised to read your remark that the midwife model of care is in a deathlock ... I'm sorry to hear that. Good luck!
posted by lukemeister at 7:53 PM on June 8, 2008

Shadow a doctor for a few days and see if that's what you really want to do.
As for developing a relationship with patients, yes, you can do that as an MD you just have to be more selective with your patients. The MDs I have shadowed that practice holistic medicine have their own practice, spend 30-40 minutes per patient, and generally love their work. They also however, tend to see more well-off populations who can pay out-of-pocket as their business model doesn't fit well with insurance companies pay schedules (longer time with patients = few patients per day = less payout from insurance).
On a different note, have you considered DO (osteopathy) school? You get to be called doctor, and they emphasize a more holistic approach to medicine and the patient.

As a med student, I would advise against med school unless you really want to go through all the hassle of applying, med school, internship, residency, and possibly a fellowship, (7+ years) before you settle into your career. But, if you want to do it, go for it.

In any case, to make a long post short, shadow a few docs/nurses and see if you can see yourself doing what they do.
posted by rux at 9:16 PM on June 8, 2008

The cost/benefit ratio usually comes out in favor of Nurse Practitioner, in my healthcare-management experience. Definitely more "holistic" and personal, and the time in school & training (and cost) works in your favor, too. You can do A LOT as an NP, and it sure sounds like you have the temperament and desire of an NP. Good luck.
posted by davidmsc at 10:37 PM on June 8, 2008

All three sound like reasonable options, but in general having an M.D. gives you more control over things (although the regulatory burden in medicine is still very high). For example, it would be possible as an M.D. to open your own community clinic and have several N.P.s and P.A.s working under your direction. Also, if you are interested in practicing overseas at some point an M.D. degree will allow you to go almost anywhere, whereas N.P.s and P.A.s are not recognized worldwide. The points others have brought up are valid as well.
posted by TedW at 7:43 AM on June 9, 2008