Become a nurse or physician assistant instead of a doctor (2012)
jakeseliger.com
jakeseliger.com
I originally trained in the UK, which had no structured residency programs at the time, and no matching scheme. The result was the so-called 'lost tribe' of doctors: http://careers.bmj.com/careers/advice/bmj.331.7514.s90.xml
Coming to the US, it seemed to me that the match was a massive improvement. The author claims that "Students are then obligated to attend that residency program. They can’t privately negotiate with other programs, as students can for, say, undergrad admissions, or med school admissions—or almost any other normal employment situation."
However, the key to the program (the algorithm was discussed on hn a few months ago I think??) is that a medical student can only be matched to a residency that THEY listed as an acceptable choice of employer, and where the residency listed THEM as an acceptable choice of resident. Medical students are also free to try to negotiate with residencies (before the ranking deadline)...and residency programs as just as free to say 'No'. I think it's reasonable for the hospital to promise a set period of residency training, with all pay and conditions specified up front, but only on the condition that the incoming resident makes the commitment to stay for the full program.
The resident can leave simply by giving their notice: what they are unlikely to be able to do is find another residency willing to take them on, when they've just broken their previous commitment. In fact, one of my UCLA Emergency Medicine classmates, Andrew Nerlinger, left our program just 6 months before finishing, for a better opportunity elsewhere (http://www.enduraventures.com/about-us).
I actually agree with the premise of the article, but it paints an inaccurate picture in a lot of places:
"Nurses, by contrast, can start making real salaries of around $50,000 when they’re 22. Doctors can’t start making real money until they’re at least 29, and often not until they’re much older."
Residents start making $50k salaries right out of medical school. It's only a 4 year delay from nurses.
It's not about money. It's about quality of life. Medical school is really hard. Residency is brutal. Constant unrelenting pressure. No sleep. No personal time. That alone is the reason why becoming a doctor isn't worth it for most people.
Watch the part in the video starting at 3:08 where they're half way through residency. They look like they're going to cry. I'm so glad I did those interviews because it really captures the personal sacrifices you have to make.
Here's the thing that the article failed to grasp, though. If you need to be the one doing the cutting in surgery or the one pushing medicine forward with research, you have to get that MD. Some people need to be in control and call the shots.
If that's you, do it. Make the sacrifices, because you won't be happy doing anything else.
If you can live a fulfilled life as a nurse or PA, though, it's a much better choice for most people.
Aside from nurse or PA, is APRN or ARNP. Not the same thing as a nurse at all.
My wife is an Advanced Practice Registered Nurse aka Nurse Practitioner. She's responsible for several hundred beds in a long term acute care facility, planning and setting the care for all these patients with the nursing staff carrying out her orders. MDs check their patients in and basically hand them off, leaving the critical care decisions in her hands while the MDs check back every 30 - 90 days, maybe. In our state she doesn't need to practice under some MD's license, she's a licensed care provider and prescriber in her own right. She spends a lot of time in differential diagnosis, being House. She's the most senior practicing medical person in the building.
As far as I can tell, today's NP is the general/internal medicine doc of the 1950s, with all the control and all the responsibility. If you want to be responsible for overall medical care for patients, rather than a particular specialty, understanding and improving patient health end to end, this seems like a reasonable way to go.
In a way (from a financial point of view), going to medical school is taking a bet. If you end up in certain well paid specialties (dermatology, radiology, etc), you can have a remarkable salary without a bad work schedule. Emergency medicine is also a good choice. Problem is, you have to go through med school and run up that debt before you know if you'll be getting one of those residencies.
While the article is positive about nursing and PA, I actually think the article underplays the possible compensation in these fields. Check out US News Best Jobs and look at compensation for nurses and Pas in high cost regions. In SF, the median salary for nurses is $127,670 a year! PA's tend to make a bit more. Certain nursing specialties (such as anesthesiology) are also very well compensated, often above GP physician levels, though these specialties do require a lot of training. Actually, in SF dental hygienists earn at the median 112k a year.
Just for comparison, software developers at the median in SF earn 114k a year.