The idea for this post stems from the questions registered nurses (RN) have asked me numerous times over the last decade about whether they should go to medical school to become an MD or DO. The focus of this post is for individuals over 30, although the information could be helpful to anyone looking for a change.
Disclaimer number one: Only you know your life circumstances. I cannot decide for you; if you dream of becoming a physician, go for it. Disclaimer number two: my wife is a bedside RN. By no means does any nurse NEED to go to medical school or nurse practitioner school. Being a bedside, boots-on-the-ground nurse is a fantastic, honorable job. This list is not all-inclusive, but it’s a comprehensive start. There will be some overlap. Regardless of what direction life takes you in, I genuinely wish you the best.
An RN Getting in to Medical School to become an MD
Getting into medical school is challenging and competitive. If you still need a bachelor’s degree, you will likely need to return and get one. The pre-med classes will also need to be checked off. Remember to take the Medical College Admissions Test, also called the MCAT. Studying for the MCAT is a process that takes several months, with some even taking a whole year to study for that exam. You will have to pay for the exam and likely a test-prep course. Some programs emphasize research in applicants. Medical school application and interview process also consume significant time and money. Some, like me, will not be able to get into medical school in the United States and will need to move to another country for several years. Being a foreign medical graduate makes many things much more challenging, from obtaining a residency to a fellowship. However, that is a discussion outside of this content. This leads us right into the next section on relocation.
Relocation
Do you want to move yourself and your family? You could get into the medical school in your hometown, but chances are you will have to go somewhere else. I have moved several times before settling in my current town. I lived in another country for medical school. Then, two different cities in two different states for residency and fellowship. Do you live in your hometown and have your parents help you with childcare? I would say goodbye to that. Finding the right job may not exist in your hometown. Numerous variables need to align for you to take that first job out of training. However, that is a post for another day.
Financial Burden
Medical school is expensive. The median cost of 4 years at a public medical school is over $250,000. The cost of tuition, fees, and living expenses can lead to substantial debt, which may take decades to pay off. As a registered nurse, you may already have financial responsibilities such as student loans, car payments, and mortgage payments that could make this additional burden more challenging. To pay off loans, people must push off saving for retirement, home purchases, etc. Yes, there are programs for loan forgiveness if you work a decade in a less-than-desirable location, but that brings us back to relocation.
Opportunity Costs: Money
Let us start with money. The median bedside RN salary is $81,000. I hate to break it to you, but you cannot work as an RN if you’re in medical school, at most a shift here and there. Studying becomes a full-time job, and you’ll work overtime weekly to keep up. While getting into a quarter million dollars of debt during medical school, you could have hypothetically earned $324,000 instead. I am taking certain liberties with my math because I do not include taxes. Something that is often overlooked is savings and investing for retirement. Albert Einstein called compounding interest the eighth wonder of the world. You likely will not generate income for savings or a 401k during medical school.
After completing medical school, we all desperately looked forward to receiving residency paychecks. Unfortunately, if you were used to earning $81,000 a year as a bedside nurse, you would be disappointed to learn that the median residency salary is less than $60,000 yearly. Not only will the $ 20,000-a-year reduction in salary feel like a swift kick in the butt after being out of the workforce for four years and becoming a doctor, but also consider that that salary is for up to 80 hours a week. Also, residency training lasts at least three years but could be as long as seven years. Want to subspecialize and complete a fellowship? Tack on another 2-4 years with only marginally increasing salaries during training.
Opportunity Costs: Time
The following should be considered for the next decade of your life. Do you have a family? Does the flexibility of working three shifts a week allow you to spend more time with your loved ones? Medical school and the training after that make that far more challenging. As mentioned, putting in 80 hours a week in residency takes place very often. I have heard from many colleagues who were going through training when they had a young family that they missed out on so much because of the requirements. Making arrangements for weddings, family vacations, and birthday parties and making it to soccer practice is possible but challenging. The hours are unpredictable.
During the numerous years I was away for medical school and training, I lost contact with multiple “friends” who did not understand how demanding my career was. If you work at an academic institution, ask your friendly medical student, resident, or fellow how much free time they have. A work-life balance can be challenging to achieve.
Subspecializing is not guaranteed.
This section is directed toward my particular audience on social media, which is critical care. Getting into a critical care medicine or pulmonary critical care medicine program is highly challenging and competitive. I regularly thank my fellowship program director for allowing me to train. While I was chosen for a spot, hundreds of others were not and had to fall back on their plan B option. My plan B option was to become a hospital medicine physician. Although there is nothing wrong with becoming a hospitalist, I would not have had as much passion for my specialty as I do being an intensivist. Critical care nurses are used to working with Intensivists and sometimes scoff at the hospitalists. Well, would you settle for all that training to become a hospitalist?
The light at the end of the tunnel
After completing medical school, residency, and likely fellowship, you are looking at a ten-year process. The beloved first attending paycheck arrives. None of this is financial advice. Here’s some advice—work on crushing your student loan debt as soon as possible. Financial gurus will tell you to live like a resident for the next few years. I wholeheartedly agree with that statement. After completing my fellowship, my wife and I rented a small house for a few years to sort out our financial order of operations.
That also meant I did not start retirement savings until I was 35. Your savings and investing may not begin until you’re in your 40’s. That could make quite the difference in a compound interest calculator. The other component is that many physicians have an exponential jump in lifestyle. They want to “treat themselves” and such. I recommend against that, but it’s a topic for a different post. Stay away from lifestyle creep.
When making “attending money,” salaries increase dramatically depending on your specialty, subspecialty, and desired geographical location. Here, one needs to consider taxes. You will likely fall into the 35% tax bracket with the IRS. Then, if you live in certain cities and states, you will likely have to pay additional taxes. Keep that in mind because, even though the numbers might seem significant when discussing things grossly, the net income is an entirely different story. Even after all the money deducted from taxes, I am grateful for my compensation (I live in Florida with no state income taxes). My request, however, is that rather than increasing my taxes further, the government would more efficiently use the taxes they already collect from all of us. This is a conversation outside the scope of this content.
Wrapping it up, going from RN to MD.
I repeat: Only you know your life circumstances. I cannot decide for you; if you dream of becoming a physician, go for it. This content was created with the best of intentions. But also, you should not go into it with your head buried in the sand. These components need to be considered and discussed if you want to go from RN to MD or DO.
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