r/Noctor

Going into nursing school and everything I’m hearing is “my goal is to be an NP”

I am a medically retired 28-year-old man. I did 6 years as a Navy corpsman before getting injured and medically processed out. I have some military benefits and am going into a private direct-entry nursing program. It’s very expensive, but it is working for my situation better then a public school college route, and fortunately I don’t have to pay the tuition.

Literally all I hear from the staff and the students (prospective students) is that their ultimate goal is to become an NP directly after finishing the program. The funniest one was the 46-year-old woman who literally graduated 9 months ago from a medical assisting program and is now coming into orientation realizing her $30k certificate was basically a waste of time. She’s now trying to actively get $120k for her bachelor’s in nursing. She can barely speak English, and the only real statement she could form was that her ultimate goal is to become an aesthetics NP.

It just seems like everyone here is trying to skip actual nursing and not focus on the immediate goal.

Me? I’m happy with just being a nurse. Maybe a midlevel one day, but I respect the position I’m working toward. I know it’s going to take a lot of skill and learning to truly master it. What’s wrong with just being a nurse?

I love learning and I would be happy to go to medical school and have all the knowledge and expertise. However, I've shadowed about 10 different doctors among 3 different specialties and so far, there is very little patient interaction or procedures, mostly just following up with residents and documenting or putting in orders.

I am a new grad nurse, and I want to work a few more years before I consider advancing, but I was thinking about NP or PA. Well from everything ive seen, PAs get better education, especially with clinical hours, but this sub is discouraging as far as mid-level providers go.

PAs, NPs, MD/DOs, I'd love to hear you opinions on whether any of the fields are worth pursuing more than the other. Is it possible to be a great midlevel, that can perform at their scope and is a specialist, or at that point would it just be more worth it to pursue medical school?

I’m a neurosurgeon at a large hospital and something happened recently that turned into a complete mess politically.

We have an NP who works with the hospitalist service. Honestly, clinically she was fine, no big red flags. Nurses liked her, patients liked her, never really had major complaints. Very confident personality.

A few months ago I started noticing patients referring to her as “the doctor” during consults. At first I assumed they were just confused because that happens constantly in hospitals. But then one patient specifically told me:

“Your hospitalist doctor already explained all this to me.”

I mentioned the NP by name and the patient goes, “Yeah, her.” Then I corrected them, it was actually an NP and he didn’t seem to care much.

Still didn’t think much of it.

Then one of the ICU nurses mentioned that the NP almost never corrected patients when they called her doctor. Apparently she’d say things like “I’m with the hospital medicine team taking care of you today” and just let patients assume whatever.

Things escalated when a family member filed a complaint because they later found out she wasn’t a physician after believing she was “one of the doctors managing the case.”

Administration reviewed it and apparently there were multiple witness statements from staff saying they’d heard her introduce herself vaguely before. One MA even claimed the NP once said, “It’s easier if you don’t overexplain titles to patients.”

What completely buried her was social media.

Someone found her LinkedIn where she listed herself as “Doctor of Hospital Medicine” because she had a DNP. Legally maybe defensible academically, but optics-wise it looked horrible once compliance got involved.

The medical staff office and legal department apparently lost their minds over it because neurosurgery, trauma, ICU, etc. all involve high-risk consent discussions and patients need to know exactly who is and isn’t a physician.

She was terminated last Friday.

Now the hospital suddenly has mandatory scripting for introductions.

“I’m Jane Smith, nurse practitioner with the hospitalist team.”

No deviations.

Personally, I’m happy to see hospital admin doing something about this shit. It’s getting out of hand…

Edit: I fucking used chat gpt to help me make it grammatically sound and so I could drive the point home without making it sound discombobulated, it’s AI written but it’s a true story.

I asked ChatGPT this:

Imagine you’re a human without healthcare literacy. If you were sick in the United States, would you want to see a Doctor/Physician, Nurse Practitioner, or Physician Assistant. You have to select one, and explain why.

If a PA or NP came in to see you and you have chosen to see a doctor, would you ask to see one instead?

This is the response I received:

If I had zero healthcare literacy and had to pick one for myself or my family member in the United States, I would choose a physician every time for anything beyond a very straightforward minor issue.

Not because NPs or PAs are “bad.” Many are competent, experienced, and conscientious. Some are excellent. But the average physician has substantially more standardized education and clinical training. That is just objectively true.

Roughly speaking:
Physician: 4 years medical school + 3-7+ years residency/fellowship, usually 10,000-20,000+ supervised clinical hours before independent practice.

PA: usually around 2-3 years of graduate education with a few thousand clinical hours.

NP: highly variable; some are experienced bedside nurses first, others go directly through online NP programs with surprisingly limited supervised clinical training.
That variability matters. Especially as a patient who cannot independently judge whether the diagnosis or treatment plan makes sense.

If I’m the hypothetical average patient with no healthcare literacy, I don’t have the tools to detect subtle mistakes, missed zebras, anchoring bias, premature closure, dangerous reassurance, or inappropriate prescribing. So I would optimize for depth and breadth of training. That means physician.

For very routine things:
uncomplicated UTI
refill of stable meds
viral URI
simple follow-up
vaccination

An experienced PA or NP may do perfectly fine. In many settings they absolutely do.

But the problem is that patients do not know when something isn’t routine. Chest pain that is “just reflux” until it isn’t. A headache that is “migraine” until it’s a SAH. “Anxiety” that is actually hyperthyroidism, PE, arrhythmia, autoimmune disease, etc.

The value of physician training is often not in managing the obvious case. It’s in recognizing the atypical, dangerous, or subtly evolving case.

As for the second question: yes, if I specifically wanted a physician and a PA or NP walked in instead, I would ask to see a physician.

Not rudely. Not theatrically. Just directly.

Something like:
“I’d prefer to see the physician today if possible.”
That is a completely reasonable request.

Patients are often socially conditioned to feel guilty about this, as though they are insulting someone. They are not. Patients are allowed to care about training differences. Hospitals and clinics market “provider equivalence” heavily because midlevels are cheaper labor and expand staffing capacity. But equivalence across all scopes and complexities is not supported by the evidence.
The data are messy because healthcare systems differ, supervision differs, and studies are often limited to protocolized primary care metrics. But when complexity rises, diagnostic uncertainty rises, or acuity rises, physician training matters more.

I also think there’s a distinction people sometimes avoid saying out loud:

A highly experienced ICU nurse becoming an NP after years of bedside critical care is not the same thing as a direct-entry or mostly-online NP graduate with minimal real clinical exposure.
A PA working closely with physicians in a collaborative model is different from fully independent unsupervised practice.

Those distinctions matter a lot.

So my answer is: I would choose a physician.

Yes, I would ask to see one if another clinician came in instead.

That does not mean I think all PAs/NPs are incompetent; it means I recognize there are real differences in training, standardization, and diagnostic depth.

It's been nothing but PAs and nurses doing my son's check ups and vaccines where we moved. He's one today and I'm thankful he's been nothing but healthy outside some fevers; but my other son had a lot of health issues specifically with febrile seizures and would like to talk to a doctor at some point. I don't even hate the mid levels like others, but when I had a question about my son's foreskin (it ripped at birth), the PA took a look and cleared him. Then we asked again about needing to clean it or anything and he responded "wait he's uncircumcised? Let me look again." I can't imagine the pediatrician we had for our 3 year old would miss something like that, he was a miracle worker

Long time lurker, first time poster here. I'm a part time dental attending at a large university hospital. Us attendings take turns overseeing OR dentistry for our residents to serve special needs patients who otherwise can't be seen in a conventional dental office. Normally we work with anesthesiologists (usually chief residents, sometimes attendings) to intubate and monitor because we obviously treat patients with numerous medical complexities and high airway risk.

Anyway for today's case we got this young, probably newish grad CRNA and I didn't think too much of it tbh because this patient was one of the least medically compromised individuals we've ever had (although the crna was a bit of a weirdo as he was plugging his IG and podcast to me and my residents before we began). Things were going smoothly enough but once like 2 of the machines started beeping, he silently but visibly started freaking out and darted out of the operatory for a good minute while my team and the nurses were looking at each other like wtf. He brought in an older crna and the two then left fast and got the anesthesiologist. The MD pressed a bunch of buttons and the beeping stopped. After the case got finished I asked the crna what the hell happened and he was like "oh nothing it was a software thing." Thankfully the patient was ok and we did our thing no problem.

I don't know anything about the anesthesia machines so what the hell happened here lol? All I know is this is a hell of a first introduction to crnas. When the going gets tough bring in the MD I guess 😂

Is it bad that as a PA student, I would 1000% rather have MD/DO preceptors than an NP preceptor? I do not mean any harm when I say this, but I am genuinely pushed and my knowledge and limits are tested when I’m with an MD or DO. I can’t truly speak from having a PA preceptor though because PAs are not in high quantities everywhere. However, I feel like when I am with a physician my time on the rotation is more structured and has higher quality expectations & very limited “shadowing”. I can also ask questions & typically get “why” or “how” something works! For example, if a patients disease or symptoms aren’t managed with the current tx, but they have other associated conditions or possible CIs to other common options, explain WHY/HOW to choose the next therapy/management approach. I generally get lots of patient assessments on my own and then coming to my preceptor and giving a presentation & receive constructive feedback — which is what we were taught to do. Additionally, I understand I will be a PA, not a physician, but I feel like I get to see how to best help and assist the physicians when I’m learning from them. It also pushes me to fill my gaps and the knowledge as best I can.

Again, this is just a general experience I have had. Not making a blanket statement or downplaying any profession.

I have 2 discussion questions I feel compelled to ask after months of being a fly on the wall in this sub:

⁠in the acute care hospital setting, do you see any value in having specialized nurse practitioners in areas such as general surgery post call coverage or 24/7 Sicu coverage? With residents constantly rotating in and out of the unit as an intern or pgy2, and many not giving their full effort due to lack of interest etc, I have had attendings pull us aside and say “watch this patient and don’t let (insert resident name) kill them.”

I have always been pro-resident and I am happy to participate/modify my day to day responsibilities in order to further their orientation and education, including promptly taking a backseat so they get their procedure reps in, etc.. The residents and attendings are always very appreciative and I have never worked in an academic center where this mentality of “F all Np’s” existed or where it was in any way outwardly anti-NP. If anything, the mentality is we (team of NPs and PAs) are responsible for going behind resident teams, cleaning up orders, dc-ing benzos on Geri trauma patients, addressing a BG of 350+ when no SSI or glucose checks were ordered, not resuming home cardiac meds on preop trauma patients, etc. TBH, what I have witnessed more and more frequently is off service interns handling consults and Trauma activations nearly independently with absentee supervising physicians and uppers. Which brings me to question two:

2. setting aside hate for mid-level providers, what is your honest experience and opinion about academic centers’ day to day culture of supervision and involvement in resident care of patients? Some of the stuff that falls through the cracks by the hands of residents on a daily basis without any conversation or repercussion blows my mind.

As an Np, I will never pretend to be something I am not, but I am proud to have 9 years of trauma and critical care experience under my belt and feel that I can be utilized in a manner that is highly beneficial to patients and attendings/residents. To add further context, I am constantly adding to my list of “oh I need to research this further and get a better understanding of \_\_\_\_” and following thru with growing upon my own education. I also never hesitate to ask questions and have great closed loop communication while caring for patients to ensure we as a team are all on the same page while treating critical patients.

I have always been able to recognize the value of each member of the care team and do not ever try to out throw my coverage while caring for patients, but I can’t help but recognize (even with bad apples in any and every profession, NP/MD alike) there are some serious systemic flaws I have witnessed day in and day out as an Np regarding physician and resident education and supervision. And lastly, I just don’t know how physicians would function in the high acuity environment that I have been immersed in for nine years without the help of Np’s writing notes, seeing consults, admitting patients, and being the 24/7 labor that is required to keep many of these sick patients alive 🤷🏼‍♀️. Notice I didn’t say how would they “survive“ because I know it can be done, but is that really what yall want?

For context: I am a SICU RN of 6 years turned Trauma/SICU NP since 2023 (9 years experience total) I have never called myself a doctor nor would I ever be comfortable allowing that misconception without correction before continuing the conversation with any patient/family or otherwise. I have consistently worked with surgical residents, ortho residents, and EM residents (especially rotating their month in SICU) my entire nursing and NP career.

see the link!!

support the comments with horror stories linking from r/Noctor about NPs misdiagnosing literally everything and everything, all while completing school online in just 6 months!

let's change the narrative, or at least get it rolling on Reddit! it starts with posts like this!

So this is the second time it’s happened to my brother and me. I’m happy my mom is a doctor (another country) but god imagine anyone else?

The first time I go I knew it was a nurse practitioner and didn’t want to see her but I needed the prescription. I ended up getting steroids even though I had a high fever and signs of infection.

My brother went to urgent care and again had a high fever and signs of infection (tonsillitis) and again steroids.

What is happening? Why are we allowing this?

They don’t know to send anything else besides steroids for literally everything?

We (physicians) should call ourselves something else 🫪

Edit: I meant we need another prefix like “Dr.” (we already do have an exclusive title “physician”).

Sup, I’m a 23 year old just graduated from PA school yesterday. Alright so, why did I post this? I essentially got shitted on for 3 hours at my graduation party by my family for being a “fake doc” (never would claimed to be a doc). I come from an Asian household filled with surgeons.

Why did I become want to be PA? Easy, I want to be the supervising physician’s right hand man and ease the load for him/her. Essentially make their lives easier. Never wanted to be the person calling the shots.

Anyways I wanted the infamous Noctor take on this: Are PA that bad?

I’m a primary care physician and I’ve had a long relationship with this patient. She’s smart and put together but seems to be easily influenced. I’m sure this is due to distrust of the system from an issue in the past. This has led to her seeking advice from some less than stellar “specialists”. I’ve been able to gradually make some progress and build trust with her. Nonetheless, she came to see me recently after a hospitalization for what was thought to be a stroke due to a nerve palsy seen by the eye doctor and then myasthenia gravis (negative work up). This entire episode stems from an “endocrine specialist” NP in Florida (we live in Virginia) who misinterpreted her TSH of 8.2 and free t4 at 0.6. Claimed she was clearly hyperthyroid and cut her thyroid dosing in half. She’s been on half dose for the last 3 months. This patient had months of symptoms claiming they MUST be related to hyperthyroid due to what her “endocrinologist” is saying. This led to worsening symptoms and the aforementioned hospitalization. She had rescheduled multiple appointments with me over this time but we finally sat and talked through all of previous events. Not quite sure how this wasn’t clearly determined in the hospital with multiple specialists on the case but here we are. I put her back on her normal thyroid dosing and lo and behold….shes feeling a lot better. I advised her to please just follow with me for her thyroid care ongoing.

Now, I’m just processing what to do about this negligent (maybe that’s offering too much grace….down right IDIOTIC) care from someone who claims to be a specialist in this field. 3rd year medical students can do a better job. My mind is thoroughly boggled.