I graduate with a doctor of nursing practice (DNP) degree in May of 2017. At that time, provided I pass the nurse practitioner exam, I will be a family nurse practitioner (FNP) with a doctorate degree. If all goest to plan, in May 2017 I can start calling myself Dr. Blue instead of Mrs. Blue. That's all well and good but what I do to get myself through this long-haul of a degree is fantasize about jobs I'll be able to get when I graduate.
With all due respect to my primary care idol, there are times when I don't want to go into primary care at all. Primary care, whether practiced by a MD or an NP is one of the lowest paid areas one can work in. The sad truth is that primary care doctors do the majority of their work with their brains and less work performing billable procedures and expensive exams. Because non-glamourous brain work is less valued by insurance companies, and arguably American society, you can make much more money if you go into a specialty like cardiology, dermatology etc.****
Another problem with primary care is that despite it's low compensation, it is incredibly challenging. You have to know something about EVERYTHING. Sure, you see some things, like back pain and upper respiratory infections, more than others but you also have to be on the constant alert for less common conditions. For example, last week we had a patient with throat pain. It's sore throat season, but he has a history of cancer. Guess what? The sore throat was his cancer rearing its ugly head again. Sometimes, your patient has a mystery disease. You try to figure it out yourself. You send them to every specialist known to man and no one can figure it out. At the end of the day, the patient comes back to you looking for the answer even when you don't have it. You don't have the luxury the cardiologist has to say "well it's definitely not your heart so... see ya later!".
Don't think that I'm a jerk. All those things that make primary care difficult, also make it beautiful, interesting, challenging, and rewarding. And that's a good thing. My resentment lies in the fact that I believe primary care is an invaluable piece of our healthcare system that is undervalued and under-compensated. If primary care was the highest paid specialty, I'd choose it no question if for no other reason than the excitement of spending a career trying to learn as much as possible about medicine and humans and being a badass primary care provider.
Some days I'm less energetic. I just want to graduate and get a cushy job that pays relatively well. And that's a definite option. On these days I imagine working in a fancy dermatology office with no on call hours and a nice paycheck. Maybe I'll even get friendly with the adjoining cosmetic dermatology office and pop over for free facials after work.
Other days I imagine working at a heart failure clinic helping people find the delicate balance between fluid overload and low blood pressure so they can avoid yet another hospitalization while making big bucks.
Sometimes I imagine becoming some kind of addiction yoga guru based on my doctorate research. I'll help millions recover from addiction at a low cost to the healthcare system through the simple vehicle of 12 step programs and yoga. Soon after having this fantasy I get overwhelmed and my thinking becomes much more black and white.
This week, a sensible career path involved the army. Sure, I told off a recruiter when I was 16 for recruiting at my high school and protested against the Iraq war, but joining as a medical person isn't really engaging in warfare. You're just taking care of people who are doing the real warring. I kind of already do this job as a civilian nurse when I take care of a veteran. So why not get all the perks the active duty job entails like loan repayment, a good retirement, a nice salary, adventure, and awesome travel opportunities? Or maybe I'm just turning into a real southerner. In any event, for the sake of blogging, let's just say joining the army as a nurse practitioner is a socially acceptable career move for Mrs. Blue.
So I called the army to get the deets. As I suspected, it sounded like a really good deal. When I asked about pay the recruiter told me that you come into a rank based on your education. Everyone in the rank however, fits into a certain pay-scale. So even, though I'd be a medical person, I would be paid according to my rank. And as it turns out, when you enter the army with a doctorate degree, your rank is "captain". For some reason, the idea of being a captain is way cooler to me than being a doctor and I got excited. "So, you're telling me I'd be a doctor captain if I joined the army and people would call me Dr. Captain?" I asked the recruiter. He brought me back to earth by telling me that "they don't call people doctor captains in the army". Shortly after we wrapped up our talk and I asked him if there was anything else I should know as potential army captain nurse practitioner. This is when the second zinger hit. Did you know you're not allowed to have depression and join the army even if:
and definitely not if you take medication for the depression. So, because I have super stable depression that I have taken medicine for half my life, in one short afterthought I was disqualified from the army. When I asked about the rationale for this rule, the recruiter told me that rule was a result of the high suicide rate in the army. I tried to explain to him that a person who is aware of their disease and takes good care of themself, is less of a suicide risk than someone who does not understand their disease or lacks insight and has undiagnosed, untreated depression but he wasn't interested. He did say that rules in different armed services vary and encouraged me to call the navy or the air force.
If they agree to call me a doctor captain, I may be interested.
****
Though a family nurse practitioner (FNP) degree trains you for primary care, you can also easily obtain a job in a specialty office.
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| Nursing education is a maze |
With all due respect to my primary care idol, there are times when I don't want to go into primary care at all. Primary care, whether practiced by a MD or an NP is one of the lowest paid areas one can work in. The sad truth is that primary care doctors do the majority of their work with their brains and less work performing billable procedures and expensive exams. Because non-glamourous brain work is less valued by insurance companies, and arguably American society, you can make much more money if you go into a specialty like cardiology, dermatology etc.****
Another problem with primary care is that despite it's low compensation, it is incredibly challenging. You have to know something about EVERYTHING. Sure, you see some things, like back pain and upper respiratory infections, more than others but you also have to be on the constant alert for less common conditions. For example, last week we had a patient with throat pain. It's sore throat season, but he has a history of cancer. Guess what? The sore throat was his cancer rearing its ugly head again. Sometimes, your patient has a mystery disease. You try to figure it out yourself. You send them to every specialist known to man and no one can figure it out. At the end of the day, the patient comes back to you looking for the answer even when you don't have it. You don't have the luxury the cardiologist has to say "well it's definitely not your heart so... see ya later!".
Don't think that I'm a jerk. All those things that make primary care difficult, also make it beautiful, interesting, challenging, and rewarding. And that's a good thing. My resentment lies in the fact that I believe primary care is an invaluable piece of our healthcare system that is undervalued and under-compensated. If primary care was the highest paid specialty, I'd choose it no question if for no other reason than the excitement of spending a career trying to learn as much as possible about medicine and humans and being a badass primary care provider.
Some days I'm less energetic. I just want to graduate and get a cushy job that pays relatively well. And that's a definite option. On these days I imagine working in a fancy dermatology office with no on call hours and a nice paycheck. Maybe I'll even get friendly with the adjoining cosmetic dermatology office and pop over for free facials after work.
Other days I imagine working at a heart failure clinic helping people find the delicate balance between fluid overload and low blood pressure so they can avoid yet another hospitalization while making big bucks.
Sometimes I imagine becoming some kind of addiction yoga guru based on my doctorate research. I'll help millions recover from addiction at a low cost to the healthcare system through the simple vehicle of 12 step programs and yoga. Soon after having this fantasy I get overwhelmed and my thinking becomes much more black and white.
This week, a sensible career path involved the army. Sure, I told off a recruiter when I was 16 for recruiting at my high school and protested against the Iraq war, but joining as a medical person isn't really engaging in warfare. You're just taking care of people who are doing the real warring. I kind of already do this job as a civilian nurse when I take care of a veteran. So why not get all the perks the active duty job entails like loan repayment, a good retirement, a nice salary, adventure, and awesome travel opportunities? Or maybe I'm just turning into a real southerner. In any event, for the sake of blogging, let's just say joining the army as a nurse practitioner is a socially acceptable career move for Mrs. Blue.
 |
| I'm sure it's all fun and games |
So I called the army to get the deets. As I suspected, it sounded like a really good deal. When I asked about pay the recruiter told me that you come into a rank based on your education. Everyone in the rank however, fits into a certain pay-scale. So even, though I'd be a medical person, I would be paid according to my rank. And as it turns out, when you enter the army with a doctorate degree, your rank is "captain". For some reason, the idea of being a captain is way cooler to me than being a doctor and I got excited. "So, you're telling me I'd be a doctor captain if I joined the army and people would call me Dr. Captain?" I asked the recruiter. He brought me back to earth by telling me that "they don't call people doctor captains in the army". Shortly after we wrapped up our talk and I asked him if there was anything else I should know as potential army captain nurse practitioner. This is when the second zinger hit. Did you know you're not allowed to have depression and join the army even if:
- you're not going to be in combat
- it's super well controlled
- you're otherwise a model of perfect health
and definitely not if you take medication for the depression. So, because I have super stable depression that I have taken medicine for half my life, in one short afterthought I was disqualified from the army. When I asked about the rationale for this rule, the recruiter told me that rule was a result of the high suicide rate in the army. I tried to explain to him that a person who is aware of their disease and takes good care of themself, is less of a suicide risk than someone who does not understand their disease or lacks insight and has undiagnosed, untreated depression but he wasn't interested. He did say that rules in different armed services vary and encouraged me to call the navy or the air force.
If they agree to call me a doctor captain, I may be interested.
****
Though a family nurse practitioner (FNP) degree trains you for primary care, you can also easily obtain a job in a specialty office.
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