with three overlapping but distinct outcomes. How can you know which is right for you? I'll

有三種重疊但不同的結果。你怎麼能知道哪一個是適合你的呢？我將

help you decide. Dr. Jubbal, MedSchoolInsiders.com.

幫助你決定。Jubbal醫生，MedSchoolInsiders.com。

Many students interested in healthcare and medicine find themselves deciding between

許多對醫療保健和醫學感興趣的學生髮現自己在以下方面做出了決定

becoming a physician with an MD or DO, versus going down the physician assistant or nurse

成為一名擁有醫學博士或醫學博士的醫生，而不是去做醫生助理或護士。

practitioner path. After all, they all have substantial overlap, however they're also

執業醫師之路。畢竟，它們都有大量的重疊，但它們也是

substantially different. If you're the type of person who would be happy being a physician,

有很大不同。如果你是那種樂意做醫生的人。

you may not be as happy as a PA or NP, and vice versa. Do note that all three are fantastic

你可能不會像PA或NP那樣開心，反之亦然。請注意，這三種人都很出色

professions, and no single one is better than the other. You simply need to decide what

職業，沒有哪一種職業比其他職業更好。你只需要決定什麼

you value most and choose accordingly. This is a big picture overview of the three

你最看重的是什麼，並作出相應的選擇。這是對三者的一個大的概述

paths. If you want to dive deeper into any single one, we have So You Want to Be episodes

徑。如果你想更深入地瞭解任何一個問題，我們有《你想成為劇集》。

for physicians, PA's, and NP's. Links in the description.

為醫生、助理醫師和護士服務。說明中的鏈接。

Let's start with the different training paths, as this is one of the biggest differentiators

讓我們從不同的培訓路徑開始，因為這是最大的差異化因素之一

and a big reason many choose the midlevel path over the physician path.

這也是許多人選擇中級職稱道路而不是醫生道路的一個重要原因。

The doctor training path, whether MD or DO, is the longest by far. After your 4 premed

醫生的培訓途徑，無論是醫學博士還是醫學博士，都是迄今為止最長的。在你的4個醫學預科之後

years in college, you'll complete another 4 years of medical school followed by 3 to

在大學期間，你將完成另外4年的醫學院學習，然後是3至4年的學習。

7 years of residency in your intended specialty. If you want to further subspecialize with

在你預定的專業中做7年的住院醫生。如果你想進一步細分為以下幾個方面

a fellowship, add one or more years after that.

獎學金，之後再加一年或更長時間。

Both midlevel training paths, whether PA or NP, are comparatively much shorter.

無論是PA還是NP，這兩種中級培訓途徑相對來說都要短得多。

To become a physician assistant, you'll enter physician assistant school after college,

要成為一名醫生助理，你要在大學畢業後進入醫生助理學校。

which is 2 or 2 and a half years in duration. Whereas in medical school, you spend 2 years

這是兩年或兩年半的時間。而在醫學院，你花2年時間

focused primarily on didactics and 2 years focused primarily on clinic time, in PA school

主要側重於教學，2年主要側重於臨床時間，在PA學校裡。

you'll have just one year of didactics and the remaining 12 or 18 months focused on clinical

你將只有一年的教學課程，其餘12或18個月集中在臨床上。

exposure. After that, there's no residency, and you're free to start practicing as a PA

接觸。在那之後，沒有住院醫生，你可以自由地開始作為一個PA執業。

immediately. To become a nurse practitioner, you can choose

立即行動。要成為一名執業護士，你可以選擇

from two paths: traditional or direct entry. The traditional pathway involves first earning

有兩種途徑：傳統或直接進入。傳統的途徑包括首先獲得

your BSN, ABN, or MSN to become an RN after taking your NCLEX exam. Next, they attend

你的BSN、ABN或MSN，在參加NCLEX考試後成為一名RN。接下來，他們參加

a master's or doctorate program to become an NP. If you attend a full time master's

碩士或博士課程，以成為一名國家護士。如果你參加一個全日制碩士課程

program, it will generally take 2 years, but if you are undergoing a part-time DNP program,

一般來說，需要2年時間，但如果你正在接受非全日制DNP課程。

it can take up to 5. If you were to major nursing in college and take your NCLEX, you

如果你在大學裡主修護理學並參加NCLEX考試，你會

could become an RN soon after graduation and become a fully trained NP just 2 years later.

可以在畢業後很快成為一名護士，並在兩年後成為一名受過全面培訓的護士。

The second pathway, or direct entry nurse practitioner programs, are for those who earned

第二種途徑，即直接進入護士執業計劃，是為那些獲得了

a bachelor's degree in something else. These are 3-5 year programs, where you will take

其他方面的學士學位。這些是3-5年的課程，你將參加

both the NCLEX to earn your RN but also complete a master's or doctorate program to become

既要通過NCLEX考試獲得註冊護士資格，又要完成碩士或博士課程，成為註冊護士。

an NP. It's not just the duration of training, but

一個NP。這不僅僅是培訓的時間，而是

also the competitiveness and rigor of each path. Getting into medical school is by far

以及每條道路的競爭力和嚴格程度。到目前為止，進入醫學院是

the most competitive of the three. At some schools, like at UCLA when I was there, over

在這三所學校中，競爭最為激烈。在一些學校，比如我在加州大學洛杉磯分校的時候，超過了

80% of premeds on the first day of college are no longer premed by graduation time. And

在大學的第一天，80%的預科生在畢業時已經不再是預科生了。而且

of those who do ultimately apply to medical school, only 40% get accepted. The average

在那些最終申請醫學院的人中，只有40%被錄取。平均而言

matriculant stats are 83rd percentile on the MCAT and a 3.73 GPA.

預科生的統計數字是MCAT的第83位，GPA為3.73。

After medical school, PA school is next in the order of competitiveness. The average

在醫學院之後，PA學校在競爭力方面位居第二。平均而言

GPA for accepted PA students is 3.5 and they average around the 40th to 50th percentile

被錄取的PA學生的GPA為3.5，他們的平均成績在第40至50名左右。

on the GRE. Note that they do have a lower average acceptance rate at 33% of all applicants,

在GRE考試中。請注意，他們的平均錄取率確實較低，佔所有申請人的33%。

and this sometimes confuses students into thinking PA school is more competitive. When

而這有時會使學生混淆，以為賓夕法尼亞州的學校競爭更激烈。當

you consider the outcome if the average premed with higher stats applied to PA school, or

你考慮一下，如果普通的預科生有更高的統計數字，申請到PA學校，結果會怎樣？

the average pre-PA student with lower stats applied to medical school, it generally clarifies

統計數據較低的普通預科生申請醫學院，一般來說，它闡明瞭

any confusion. Do note that many PA schools also require

任何混淆。請注意，許多賓夕法尼亞州的學校還要求

over 1,000 hours of direct patient healthcare experience prior to matriculating. This doesn't

在入學前有超過1,000小時的直接病人保健經驗。這並不意味著

make it any more competitive, but you will need to spend considerable time putting in

使其更有競爭力，但你需要花相當多的時間投入到

those hours. While premeds don't need 1,000 hours of direct patient experience, they do

這些時間。雖然預科醫生不需要1000小時的直接病人經驗，但他們確實需要

need to put in several hundreds of hours across multiple extracurriculars including clinical

需要在多個課外活動中投入幾百個小時的時間，包括臨床工作。

experience, research, volunteering, leadership, and others.

經驗、研究、志願服務、上司和其他。

NP school is the least competitive of the three and it has the loosest requirements.

NP學校是三個學校中競爭最不激烈的，它的要求也最寬鬆。

Some programs require 1 to 2 years of prior nursing experience, while others don't require

有些項目要求有1至2年的護理經驗，而其他項目則不要求。

any. GPA isn't highlighted as a primary factor, with most GPA cutoffs around 3.0, but this

任何。GPA並沒有被強調為一個主要因素，大多數GPA分數線在3.0左右，但這

isn't a hard rule. Middle Tennessee State University, for example, is reported to generally

並不是一個硬性規定。例如，中田納西州立大學，據報道，一般來說

accept applicants with a GPA of 2.9 or greater. When it comes to rigor, your clinical years

接受GPA為2.9或以上的申請人。說到嚴格性，你的臨床年限

in medical school and your residency years will be extremely trying. The norm is to be

在醫學院，你的住院醫師生涯將是非常艱難的。通常的情況是

working 70 to 80 hours per week, but expect over 80 hours in most surgical specialties.

每週工作70至80個小時，但在大多數外科專業中預計會超過80個小時。

With the PA and NP training paths, you won't be expected to put in such long hours or for

有了PA和NP的培訓途徑，你將不會被期望投入這麼長的時間或為

so many years. In terms of cost, medical school is the most

這麼多年了。就費用而言，醫學院是最

expensive, followed by PA school, followed by NP school. The average annual tuition for

昂貴，其次是PA學校，再其次是NP學校。每年的平均學費為

medical school is $40,000 to $60,000 and graduates have an average debt burden close to $200,000.

醫學院的學費是40,000到60,000美元，畢業生的平均債務負擔接近200,000美元。

The average annual tuition for PA school is about $45,000 with average graduating debt

PA學校的平均年學費約為45,000美元，平均畢業時的債務

burden approximately $110,000. NP schools average between $18,000 to $32,000 per year,

負擔約110,000美元。非營利性學校每年平均在18,000至32,000美元之間。

with the average graduating debt burden between $40,000 and $60,000 depending on the source.

畢業生的平均債務負擔在40,000至60,000美元之間，取決於來源。

If you're finding the video helpful, let me know with a thumbs up, and consider gently

如果你覺得這個視頻對你有幫助，請用大拇指告訴我，並考慮輕輕地

tapping the subscribe button and notification bell with surgical precision.

以外科手術般的精準度敲擊訂閱按鈕和通知鈴。

Considering the training paths, it's natural to assume that physicians have the deepest

考慮到培訓路徑，我們很自然地認為，醫生擁有最深的

knowledge and expertise when it comes to the body and how to treat its various ailments.

當涉及到身體和如何治療其各種疾病時，他的知識和專長。

If you assume that, then you would be correct. Not only do physicians spend the most time

如果你這樣假設，那麼你是正確的。醫生不僅花費最多的時間

focusing on the foundations, but they also spend several years focusing on their specific

側重於基礎，但他們也花了幾年時間專注於他們特定的

specialty in residency. The knowledge of midlevels is substantial,

在住院醫師中的專業。中層人員的知識是很豐富的。

but as the name describes, is less than that of physicians. NP's and PA's spend far less

但正如其名稱所描述的那樣，比醫生的費用低。非執業醫師和執業助理醫師的花費要少得多。

time in training than physicians, and therefore don't have the same depth of expertise.

與醫生相比，他們受訓的時間更長，是以不具備相同的專業知識深度。

Physician assistants follow the medical model, similar to physicians, while nurse practitioners

醫生助理遵循醫療模式，與醫生類似，而執業護士

follow the nursing model. But note that after completing PA school or NP school, you're

遵循護理模式。但要注意的是，在完成PA學校或NP學校後，你的

fully trained and able to join the work force, without any required residency for specialty

經過充分培訓，能夠加入工作隊伍，不需要任何專業的住院醫師。

training. PA's and NP's get a great deal of their specialty training on the job after

培訓。醫務人員和護士在工作中接受了大量的專業培訓。

joining a practice. While this is very useful in getting up to speed quickly with pattern

加入一個實踐。雖然這對於快速掌握模式非常有用

recognition for common presenting concerns, you won't be well equipped to identify and

識別常見的問題，你就不能很好地識別和處理這些問題。

manage rare or complex conditions. Given the on-the-job training, it's also much

管理罕見或複雜的情況。鑑於在職培訓，它也是多

easier to change specialties later in your career if you get bored of one or want a change

如果你厭倦了一個專業或想改變，在你的職業生涯後期更容易改變專業

of pace. That's not feasible to do so for physicians, who would have to reapply to residency

的步伐。對醫生來說，這樣做是不可行的，他們必須重新申請住院醫師資格。

and complete another 3 to 7 years of structured training. PA's are considered to have the

並完成另外3至7年的結構化培訓。助理醫師被認為具有

most flexibility and are sometimes found in surgical specialties, either handling pre-

最具靈活性，有時會在外科專業中發現，要麼是處理預先的

or post-operative patient floor work or assisting in the operating room. NP's have flexibility

或術後病人地面工作或在手術室協助工作。護士長具有靈活性

as well, but you'll need to be intentional with which program you attend, as each program

也是如此，但你需要有意識地參加哪個項目，因為每個項目

trains you toward a specialization, such as primary care, acute care, family, women's

培養你的專業方向，如初級保健、急症護理、家庭、婦女和兒童保健。

health, and so on. If you are interested in surgery, note that

健康，等等。如果你對手術感興趣，請注意

only surgeons with an MD or DO are qualified and have the sufficient knowledge and expertise

只有擁有醫學博士或醫學博士的外科醫生才有資格，才有足夠的知識和專長。

to perform surgery. With the PA or NP routes, the most you'll be able to do in the OR is

來進行手術。通過PA或NP路線，你在手術室裡最多可以做的是

be first assist, helping the surgeon by retracting, suctioning, suturing, and the like. That's

是第一助手，通過牽拉、抽吸、縫合等方式幫助外科醫生。這就是

the level of responsibility of a medical student or junior resident. Which brings us to the

一個醫科學生或初級住院醫師的責任水準。這使我們想到了

hotly debated topic of scope of practice. Scope of practice refers to what each type

激烈爭論的執業範圍問題。執業範圍是指每種類型的

of professional is expected and allowed to do.

的專業人員被期望和允許做。

Historically, the NP and PA training paths were created to address a shortage of primary

從歷史上看，創建全科醫生和助理醫生的培訓途徑是為了解決初級醫生短缺的問題。

care physicians and were to serve as an adjunct to physician-led care, not as a replacement.

護理醫生，並作為醫生主導的護理的輔助手段，而不是替代手段。

In this model, NP's, PA's, and physicians all work together in harmony in service to

在這個模式中，非執業醫師、助理醫師和醫生都在一起和諧地工作，為以下人群服務

the patient. Since physicians have the most robust knowledge and training, midlevels were

醫師有最豐富的知識和培訓。由於醫生擁有最強大的知識和培訓，中層人員是

generally working alongside physicians, and would easily be able to ask for assistance

一般來說，他們與醫生一起工作，可以很容易地請求幫助。

on more complex or rare presentations. Physicians and midlevels have worked harmoniously

在更復雜或罕見的情況下。內科醫生和中層醫生和諧地工作

as designed for several decades. However, in recent years, there's been a growing power

幾十年來都是如此設計的。然而，近年來，有越來越多的力量

struggle between physicians and midlevels over scope of practice.

醫生和中層管理人員之間關於執業範圍的鬥爭。

On one hand, NP's and PA's are lobbying for greater scope, meaning they want to do more

一方面，護士和助理醫師正在遊說擴大範圍，這意味著他們想做更多的事情。

things physicians traditionally do, such as independent practice. The primary arguments

醫生傳統上做的事情，如獨立執業。主要論點

are two-fold: first, we have a shortage of primary care physicians, and midlevels can

有兩方面的原因：首先，我們的初級保健醫生短缺，而中級醫生可以

help alleviate that. And second, they argue that midlevels receive sufficient training

有助於緩解這種情況。其次，他們認為，中層人員接受足夠的培訓

to practice independently and safely. On the other hand, physicians are pushing

以獨立和安全地執業。另一方面，醫生們正在推動

back, primarily focused on patient safety concerns. After all, NP's and PA's receive

回，主要集中在病人安全問題上。畢竟，國家執業醫師和助理醫師接受的是

far less training. My physician mentors and colleagues have shared they find the NP's

訓練少得多。我的醫生導師和同事們都認為，他們認為非執業醫師的

and PA's in their practice are valuable in handling much of the bread and butter, meaning

在他們的實踐中，助理醫師在處理許多面包和黃油方面很有價值，這意味著

the most common and simple cases. However, when it comes to a complex or rare presentation,

最常見和最簡單的病例。然而，當涉及到複雜或罕見的表現時。

the training differences are starkly contrasted. But are physicians really more qualified?

培訓差異形成了鮮明的對比。但醫生真的更有資格嗎？

Comparing the expertise and capabilities of someone who receives over 20,000 hours of

比較一個接受過20000小時以上培訓的人的專業知識和能力。

supervised patient contact compared to just 500 to 2,000 seems like a no-brainer. It would

監督的病人接觸比起只有500到2000人的接觸似乎是一個沒有問題的事情。這將

seem obvious that the physician with 20,000 hours will have greater clinical expertise

似乎很明顯，擁有20000小時的醫生會有更多的臨床專業知識

than the NP or PA with a small fraction of that. The only way for all parties to be equally

比NP或PA的一小部分。所有各方平等的唯一途徑是

qualified, despite the massive difference in training hours and rigor, is if the following

儘管在培訓時間和嚴格程度上存在巨大差異，但合格的是如果

assumptions are true: either medical school is massively less efficient and medical students

假設是真的：要麼醫學院的效率大大降低，醫學生

massively less intelligent or capable, or if midlevel training paths are massively more

智慧或能力大大降低，或者中級培訓途徑大大增加了

efficient and their students massively more intelligent or capable.

效率很高，他們的學生的智力或能力都大大增強。

Scope of practice creep is very much about money. After all, if you're able to do more

執業範圍的蠕變在很大程度上與金錢有關。畢竟，如果你能做得更多

and practice more independently, similar to a physician, then you can make closer to a

並更加獨立地執業，類似於醫生，那麼你就可以賺取更多的錢。

physician salary. The average primary care physician makes $240,000 per year and the

醫師工資。初級保健醫生的平均年薪為240,000美元，而

average specialist physician makes $340,000. In comparison, NP's average approximately

專家醫生的平均收入為34萬美元。相比之下，NP的平均收入約為

$110,000 per year and PA's average approximately $100,000.

每年110,000美元，而助理醫師平均約100,000美元。

Note that laws governing the scope of practice for each type of healthcare professional vary

請注意，關於每類醫療保健專業人員的執業範圍的法律是不同的

from state to state, which adds further complexity to the situation.

從一個州到另一個州，這使情況變得更加複雜。

The reason this is important and you should care is because of patient safety. If you

這很重要，你應該關心的原因是病人的安全。如果你

or anyone you care about will ever receive any medical care, then this is deeply relevant

或你所關心的任何人將接受任何醫療護理，那麼這就與此有很大的關係

to you. The fields that are currently most significantly affected by scope creep include

給你。目前受範圍蠕變影響最嚴重的領域包括

anesthesiology and primary care. But go on Reddit or med-Twitter and you'll see other

麻醉學和初級保健。但是，在Reddit或Med-Twitter上，你會看到其他的

specialties cropping up. Ultimately, the surgical specialties are the safest from scope creep

越來越多的專科出現。歸根結底，外科專業是最安全的，不會出現範圍蠕動。

issues. If scope creep is ultimately harmful to patients,

問題。如果範圍蠕變最終會對病人造成傷害。

then why has it gone so far? Two main reasons: first, in the current climate of prioritizing

那麼為什麼會走得這麼遠呢？主要有兩個原因：第一，在當前優先考慮的環境下

emotions over facts, many organizations are focused on inclusion to a fault. Being equal

情感重於事實，許多組織對包容性的關注到了極點。平等

as humans doesn't mean that we all have equal training and capabilities. Second, and more

作為人類，並不意味著我們都有同等的訓練和能力。第二，更重要的是

importantly, the AANP and AAPA are much more effective at lobbying compared to the AMA

重要的是，與AMA相比，AANP和AAPA的遊說工作更加有效。

and physicians. It's easy to point to the insanely demanding schedules of physicians

和醫生。我們很容易指出，醫生們的日程安排非常苛刻

to explain why they don't have time for advocacy work, but that has to change. If you are looking

來解釋他們為什麼沒有時間做宣傳工作，但這必須改變。如果你正在尋找

to learn more, get involved, and make a difference, check out the Physicians for Patient Protection.

要了解更多資訊，參與其中，並有所作為，請查看醫生保護病人協會。

Link in the description. In deciding between the three paths, there

說明中的鏈接。在決定這三條道路時，有

is no correct answer – you need to decide what is important to you. Are you willing

沒有正確的答案--你需要決定什麼對你來說是重要的。你是否願意

to work extra hard as a premed and crush the MCAT to get into medical school? If not, the

作為一名醫學預科生，要想進入醫學院，就必須付出額外的努力，並在MCAT考試中取得好成績？如果不是，那麼

PA and NP paths are much more attainable. Do you prioritize shorter training and lifestyle,

公務員和國家護士的道路更容易實現。你是否把較短的訓練和生活方式放在首位。

or being the expert of your field at the expense of your 20's and even early 30's? Do you want

還是以犧牲你的20歲甚至30歲出頭的年齡為代價，成為你所在領域的專家？你是否想

to perform surgery, or would being first assist in the operating room be enough? How important

在手術室裡做第一助手就夠了嗎？有多重要

is income compared to these other factors? I dive into all these details and more on

收入與這些其他因素相比是什麼？我深入研究了所有這些細節，以及更多關於

my So You Want to Be a PA and So You Want to be an NP videos. Much love, and I'll see

我的《你想成為一名助理醫師》和《你想成為一名護士》視頻。非常愛你，我會看到

you guys there.

你們在那裡。