M.D. to NP Education Programs: Mixed feelings

I was reading a Facebook post the other day discussing a program for M.D.s to become nurse practitioners and I was like, “What the heck” is this?  My immediate guttural reaction was this is crazy, this is ridiculous, this is insane. Why would someone who has dedicated now 8 years of undergraduate education and medical school, who holds an M.D. medical degree, spend more time and money to become a nurse practitioner.  It actually boggled my mind since I had done the exact opposite and transitioned from an NP to an M.D in the early 2000’s. For those who can’t believe this, it is actually happening with several programs including http://www.clinicalclerkship.org/md-to-np-program/.

As I read the reactions it became clear.  Just as our healthcare system is broken, so it our medical education system.  Medical students accrue more debt that any other profession, upwards of 200K-300K.  Then when they graduate from medical school there is no guarantee they will secure a residency program that is required for a physician to obtain licensure.

Congress determines the funding for the available residency slots, and I recall hearing something about physician organizations encouraging restrictions many years ago to keep demand high, but I was not around at that time and will not accept responsibility for the shortage of residency slots being shouldered on today’s physicians.  With the recent Hahnemann Hospital fiasco and hundreds of residents and fellow physicians futures put in limbo it further shows how screwed up our medical education training system is in the United States. International medical graduates and from what I understand our own US trained medical graduates are unable to secure residency spots to complete their required training.  With a public outcry about the impending physician shortage and the need to place less qualified PAs and NPs to filled these spots and government money encouraging this nonsense the problem gets worse and worse. I hear stories of medical school graduates working as waiters/waitresses and Uber drivers and it breaks my heart. The talent that is being wasted is sickening.  

Then comes a possible solution.  An M.D. to NP program to help these unfortunate folks to be able to bridge to become an NP and provide clinical services.  Another quick fix which is what our country is all about. Instead of fixing this perversely incentivized culture, we put a bandage on the problem and make these new, but unemployable M.D.s jump through more hoops, acquire more debt just so they can make a living to pay off an immeasurable amount of medical school debt.

At first glance, I was abhorred to see this happening, but upon further thought I realize this at least lets them utilized their knowledge and practice is some field where they can do good and help people.  I wonder how they will be addressed, they do have an M.D. degree and deserve the title of “Doctor”, but will they need to provide a disclaimer that they are actually licensed as an NP. The public is already confused the multitude of medical providers and the purposeful deception set by corporate entities to educate DNP and push them the use the “Doctor” title to further confuse the unsuspecting public.  But these M.D’s in limbo deserve a chance to earn a livelihood, and I have mixed feelings about these M.D. to NP programs. If this is the only way for them to be able to secure employment and provide services to the public, I will support; but I implore anyone who will listen or who is in a position to make a change, to fix the problem and open up the number of residency slots to get more fully trained physicians in the workforce to prevent the impending crisis.  The push for unsupervised midlevel providers is not the answer to the impending physician shortage. Legislative changes and incentives to encourage more students to go into primary care medicine is.

Jaclyn Nadler MD

Jaclyn S. Nadler, MD, MBA, FACP is a practicing internal medicine physician in Southwest FL. She received her medical degree from the University of Miami and undergraduate (BSN) and graduate (MSN/ARNP) training from the University of Florida in Gainesville. She attended residency at Wake Forest Baptist Medical Center in Winston-Salem, NC and completed her MBA degree with a concentration in medical management from UMass, Amherst. Dr. Nadler recently joined the Direct Primary Care/DPC movement when she became disillusioned with the current state of healthcare including physician abuse, corporate medicine’s focus on quantity of care over quality and the loss of physician autonomy. She started her own DPC clinic, CoastalMED DPC in January 2019 where she can practice medicine on her own terms and provide her patients with the time and superior care they have grown the expect. She is passionate about physicians regaining their rightful place at the helm of healthcare and physicians reverting back to independent practice and regaining autonomy. She is a member of the Florida Medical Association and Direct Primary Care Alliance, she is a Fellow in the American College of Physicians and received her certification as a physician executive (CPE) through the American Association of Physician Leaders. You can learn more about Dr. Nadler and view her blog at www.JaclynNadlerMD.com 

  8 comments for “M.D. to NP Education Programs: Mixed feelings

  1. Cindy
    August 7, 2019 at 11:00 pm

    Are the medical school grads who are not landing residencies the ones who rank low when they apply to programs so they do not match with any programs they have applied to?

    • Jaclyn Nadler
      August 8, 2019 at 7:56 am

      I believe so, it’s one of the flaws with the match system. Traditionally IMG were the ones having a hard time securing a residency, but with the increasing number of US medical school graduates and limited residency spots it has now overflowed to US grads, https://www.statnews.com/2016/03/17/medical-students-match-day/
      SOAP is the backup for unmatched students who as you mentioned may have placed unattainable residency spots high on the match system; when I did my training the “scramble” was available. But these mechanisms are not longer working since to my understanding the residency slots just don’t meet the number of students graduating.

    • Natalie Newman, MD
      August 19, 2019 at 1:09 pm

      Not all of these students rank low. Since there are not enough residency slots, it is not as simple as that. Even quality grads are being rejected. They reapply sometimes 3-4 times. The Centers for Medicare placed a cap in 1997 that never should have lasted this long. The projected surplus of physicians that was expected never occurred. The opposite happened. No one considered the fact that people would be living longer, EHRs and corporate medicine would come into play and baby boomer physicians would be retiring in droves. There was no one to replace them…so here we are. Lots of new MDs/DOs with nowhere to go. An absolute travesty.

  2. Anu Verma
    August 5, 2019 at 11:24 pm

    Thanks for writing about this.
    It really is sad and incomprehensible.
    I know that medical school was the hardest thing I ever did and my heart goes out to the doctors in this situation.

  3. Diane Bergmann
    August 5, 2019 at 9:29 pm

    This is just sad beyond belief. The system is totally broken.

  4. Bridget Reidy
    August 5, 2019 at 7:44 pm

    In BC they pay NPs much better (in primary care) and expect much less. We trie to apply for the NP positions but they said no.

  5. KH
    August 5, 2019 at 7:00 pm

    This could also be a path for an MD to switch specialties. One cannot be a dermatologist, for example, without applying for and obtaining another residency position. We regulate this by the board of medicine. There is no such regulation by Board of nursing for NPs. I assume it’s because one always thought an MD/DO would be of oversight. However, in now 23 states, NPS are unsupervised. Therefore, they can be a dermatologist today and a cardiologist tomorrow with no oversight and no regulation. That, I believe, is a travesty.

    Much easier to go to online Nps school with your MD, get your 500-1500 clinic hours (about 5months with standard residency hours), move to an unsupervised state, and practice whatever it is that your heart desires with no board of nursing judgment and out of jurisdiction of medical boards. Great loophole…..

  6. Rick
    August 5, 2019 at 6:32 pm

    I find it unfathomable that a physician would settle for working as a nurse.
    Beyond reason.

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