Direct-admit PA program with huge debt or BSN with little/no debt? WWYD?

[fourisenough]

Folks, we're going a little batty over here trying to make a college decision for DD17. We thought we had a decision, but turns out none of us are fully resolved on the matter (neither DH, DD, nor me). It's go time: we have until next week to commit.

 

She is debating three different scenarios:

 

1) Direct-admit spot in nursing* program at small liberal arts college with a competitive D2 swim team. Great fit athletically, good fit academically, good fit financially. She could graduate with <15K debt (possibly none). She really likes, but doesn't love the school; weather, size, dorms, people are all strong benefits.

 

2) Direct-admit spot in nursing* program at large, regional state school with competitive D2 swim team. Great fit athletically (ADORES the coach, knows & likes some of the swimmers), decent fit academically, excellent fit financially (nearly full scholarship). She could graduate with about $40k remaining in her college fund for graduate school. School is urban, gritty, largely a commuter campus, and just doesn't excite her in any way. Nursing school has a great reputation and a 100% pass rate on the NCLEX exam for last few years. Basically, she'd get a great professional education in a no-frills setting, while probably having a very fun/rewarding college swim career.

 

3) Direct-admit spot in 6-year Physician Assistant program at a small, prestigious liberal arts university with a non-scholarship D1 swim team. Great fit athletically, great fit academically, terrible fit financially. She (we?) would graduate with >$200,000 in student loans (BUT with 100% employment and a starting salary of >$100,000). It is one of the best PA programs in the country at a school with a really cool student-athlete culture (both DH and I, along with my dad and two sisters are alums and DH was an athlete there).

 

*She plans to continue her education to earn a DNP or CRNA shortly after undergrad, so she'd ultimately be the same 'level' as a PA - either a NP or Nurse Anesthetist. Don't flame me - we realize there are big differences in how nurses/PAs are trained and how they function in different settings, but for our purposes right now, we're considering them all to be mid-level providers and basically comparable. It would cost somewhere between $60,000-$120,000 for a graduate nursing degree.

 

So, what says the hive? 

[Lori D.]

If we're voting (lol): 

First choice = #2

Second choice = #1

Drop #3 entirely.

 

Choices #1 and #2 seem completely equal to me, with the exception of the swim coach, which tips me in favor of option #2, plus that leaves money in the bank for grad school. Either of those options looks like a winner, and DS will likely make friends quickly and enjoy her college experience either way.

 

#3 is just completely off the table for me, since the social / sports / education look equally as strong at #1 and #2 as at #3, and all you'd gain by going with #3 is a back-breaking amount of debt that would close many future doors for DD -- from choice of employment (she'd HAVE to choose a high paying job and stay with it, whether it was fulfilling or not), to possibly forcing a delay in or cutting her off from other life goals she might really want that require money -- marriage, children, owning a home, travel…  JMO! :)

Edited April 19, 2016 by Lori D.

[prairiewindmomma]

#2

#1

drop #3

 

Getting a nursing degree is going to offer her the greatest flexibility at the lowest cost. She'll still be in great position for grad school financially and she'll get to swim. #2's rep for NCLEX test scores is especially appealing.

 

Even with $100,000+ salary, $200,000+ in loans is a tremendous amount of debt. I say this as someone who got a high-earning degree and have watched my class cohort of 135 others all struggle over the past decade with student debt.  Even if she goes into practice with someone else covering the overhead, just daily living can eat up a ton of income.  I imagine she'll also be wanting to marry, have kids, etc. and it would be great to do that without that debt load over her head.

[TechWife]

If the housing is adequate or if there are plenty of nearby, safe apartments, I think I like option 2 better. With her commitment to the swim team and with a nursing major, her fellow swimmers and her nursing cohort are the people with whom she will spend most of her time, no matter where she goes to school. With that in mind, I see option 2 as stronger because of the fit with the swim team and the excellent results the nursing graduates have on their exams.

 

I totally understand how the living environment doesn't excite her. Is it possible for her to find some roommates through her contact with the swim team? Is there a roommate matching service? She could always try to add student government and attended what activities there are on campus to help her develop that connection, if she has time. There is also a lot she can do to make her dorm room or apartment welcoming to other students without becoming a party spot. There are probably some hang out spots on campus she can seek out as well. 

[anne1456]

I don't see any reason for picking #3 when you have the other options which cost less and will get her to essentially the same type of career.

 

I'd look at the attrition rate from nursing for both schools #1 and #2 before making the final decision. Some nursing programs weed lots of students out. (This is probably true of PA programs too.) My daughter is graduating in May with an associates degree in nursing, and out of 66 kids who started there are only 26 graduating in May. Some of them fell behind by a semester and are graduating in the fall, but many dropped out completely or changed majors. See if you can find out which school has a better record of getting kids through the program, because while the 100% pass rate is impressive that is only the students who go through all 4 years and graduate.

 

I'd also look at how the combination of serious athletics works with nursing. The nursing clinicals are very time consuming, so if you sense one coach is going to be easier to work with that would be a big plus. It would be ideal to talk to a current team member who is in nursing for each college if there is one. Or if not try to find a nursing student on a different athletic team for her to talk to. She is going to have to do a very good job of time management to swim competitively and get a nursing degree.

Edited April 19, 2016 by anne1456

[bettyandbob]

Drop 3

[teachermom2834]

I am not adverse to student loan debt but #3 is just too much. I saw an article in Money magazine stating that it is OK for STEM majors to take a little extra debt but the suggestion was to cap it at anticipated first year salary amount. $200000 is just too much.

[Bluegoat]

I don't see any point to 3.

 

I think I would go with #1, but not necessarily by much.  I tend to think living conditions would be more important than the sports, ultimatly.

 

On the other hand, at this point she really doesn't know how she would find the coach she likes over the long term, or the gritty urban environment.

 

I tend to favour small LA schools over large impersonal ones though, I think they have benefits in terms of flexibility and connection to students, and they also have a much more developed collegiate-academic life which is a great thing to experience.

[gingersmom]

My daughter is in a 4 year nursing program and I know how much she studies. She is involved in school activities but if she added in a sport she would have to drop everything else. Is your daughter going to stick with swimming for 4 years?

 

I would drop #3.

[plansrme]

I agree with all of the above:  drop #3.  I would not hold the urban no-frills setting of #2 against it, since it has so many other intangibles going for it (coach, swimmates, etc.).  I am sure that even with the no-frills setting, there is college fun to be had, especially if she is swimming.  I would go with #1 or #2, but I can see why this is such a difficult decision.

 

As for the student loan debt, I graduated law school with nearly the equivalent in mid-90s dollars, i.e., debt twice my starting salary, and it was not fun.  I felt like my options were limited for many years afterwards.

[Lilaclady]

I will pick #2 first then 1. Nursing jobs greatly depend on the location.

Some places like California, New York and Houston pay very well and most employers will even pay for graduate studies but not all areas pay as well.

[Crimson Wife]

BSN and then either N.P. or P.A. after graduation (possibly with employer tuition reimbursement to help pay for it).

 

I've never heard of a P.A. working as an anesthetist, only N.P's. CNA's make very good money (my cousin's wife got a job offer for $300k when she graduated her MSN program, but chose a slightly-lower-paying one in resort area).

[fourisenough]

BSN and then either N.P. or P.A. after graduation (possibly with employer tuition reimbursement to help pay for it).

 

I've never heard of a P.A. working as an anesthetist, only N.P's. CNA's make very good money (my cousin's wife got a job offer for $300k when she graduated her MSN program, but chose a slightly-lower-paying one in resort area).

Yes, you're right: DNP or CRNA would only be in the case of BSN for undergrad.

[KarenNC]

Assuming scholarships at #1 and #2, are there differences in GPA required to keep the scholarships?

[fourisenough]

Assuming scholarships at #1 and #2, are there differences in GPA required to keep the scholarships?

 

Yes, scholarships at both 1 & 2. I'll have to pull the offer letters and verify. Good point.

[VANURSEPRAC]

As an NP, I work side by side with a PA everyday and we make the same amount of money and have the exact same job. We both love our jobs. Pick #2!

 

[Jane Elliot]

Dh is an MD who employs both PA's and NP's. Although both have their benefits, he counseled ds to go the BSN to NP route because of increased flexibility. Laws vary in different states, but in most states NP's can practice independently while PA's have to be under the supervision of a physician. In our state, if ds wanted to, he could take over dh's private practice upon dh's retirement. Alternately, ds could have chosen to stop after the BSN and would have had multiple job opportunities at that level. He's a junior nursing student now and expects to pursue NP immediately after graduation.

 

We chose a school that has a guaranteed spot in the nursing program for anyone who can pass the TEAS and has kept the GPA up. (I can't remember the exact GPA cutoff.) Many schools we looked at only have spots for a percentage of the freshman who meet those criteria. Make sure you check into that.

 

eta: Dh has a lot of students do part of their training in his office. He just said that in general the NP students he has coming through have a stronger foundation than the PA students. That's in general. Experience and other factors play a part.

Edited April 20, 2016 by Jane Elliot

[G5052]

Dh is an MD who employs both PA's and NP's. Although both have their benefits, he counseled ds to go the BSN to NP route because of increased flexibility. Laws vary in different states, but in most states NP's can practice independently while PA's have to be under the supervision of a physician. In our state, if ds wanted to, he could take over dh's private practice upon dh's retirement. Alternately, ds could have chosen to stop after the BSN and would have had multiple job opportunities at that level. He's a junior nursing student now and expects to pursue NP immediately after graduation.

 

We chose a school that has a guaranteed spot in the nursing program for anyone who can pass the TEAS and has kept the GPA up. (I can't remember the exact GPA cutoff.) Many schools we looked at only have spots for a percentage of the freshman who meet those criteria. Make sure you check into that.

 

eta: Dh has a lot of students do part of their training in his office. He just said that in general the NP students he has coming through have a stronger foundation than the PA students. That's in general. Experience and other factors play a part.

 

Yes, I'd avoid the debt. We know of several STEM graduates who were actually unemployed at graduation, so I personally wouldn't recommend a lot debt in general. One finally got a job a year later in an allied area, but not directly what he had been hoping for and not for the salary he had hoped (state versus private employer). You can say "at least he's employed," but the reality is that you don't know what your salary will be. If you have a lot of debt and end up working for the state, the job itself may be great, but I'd hate to pay off $100,000 in loans on a state salary.

 

We know quite a few young people debating the LPN/RN/BSN/NP/PA route, so when I went to the local NP for a sinus infection, I asked her. She actually is an adjunct NP professor, so I knew she'd be a good source of information. In her opinion, taking the steps toward an NP is the best route right now because of more opportunity in our area and for what she hears as far as trends. Taking it step-by-step gives you flexibility as long as you are the path towards your goal. Locally, getting a BSN offers far more opportunities, but I realize that some need the intermediate steps for various reasons.

Edited April 20, 2016 by G5052

[Jane Elliot]

Yes, I'd avoid the debt. We know of several STEM graduates who were actually unemployed at graduation, so I personally wouldn't recommend a lot debt in general. One finally got a job a year later in an allied area, but not directly what he had been hoping for and not for the salary he had hoped (state versus private employer). You can say "at least he's employed," but the reality is that you don't know what your salary will be. If you have a lot of debt and end up working for the state, the job itself may be great, but I'd hate to pay off $100,000 in loans on a state salary.

 

I just wanted to note that employment with a good salary is almost guaranteed for NP's and PA's. It's kind of a special case for STEM jobs. Additionally, the same types of loan repayment programs available to MD's (which I talked about in the thread on Caribbean medical schools) are available to PA's and NP's willing to working in rural or provider shortage areas.

[FaithManor]

I would simply not be comfortable with the level of debt. While some PA's are making great money, others not so much. It depends on if they work for GP's and pediatricians, or the bigger bucks specialty practices like orthopedics. The nurses in our area though are paid well, shifts are regular, the national reciprocity works in their favor when they need to relocate, and they can always choose to go back to school later.

 

In medicine, the pass rate on those exams is everything. Normally, if there is a 95-100% pass rate it means that the program over teaches, and that is a very good thing. The student is uber prepped for exams, and for the job, not just getting by. With that in mind, and the excellent financial package offered, school number 2 would be my vote.

[Jane Elliot]

I didn't have time to say this earlier, but I do think I would be concerned about the type of debt in option #3 because you're looking at a 6 year commitment made by (I'm assuming) an 18yo. I've had too many kids that age to think that nothing would happen between freshman year and graduation six years later. Kids change their minds, find out they don't like it . . . you name it. Things happen. That's far different from a college graduate taking on debt for med school or post-graduate work.

[Sunshine State Sue]

She (we?) would graduate with >$200,000 in student loans

 

Um.  If I read your signature right, this is the oldest of 4 children.  Did your dad, your husband, you, and your sisters all take on that kind of debt?

 

Edited April 21, 2016 by Sue in St Pete

[fourisenough]

Um. If I read your signature right, this is the oldest of 4 children. Did your dad, your husband, you, and your sisters all take on that kind of debt?

 

Yes, you read signature correctly. But I'm confused by your question re: extended family's debt. Relevance? My dad graduated in 1960. His final semester cost something like $300 plus gas/oil to commute from his family's farm 20 miles away! They didn't borrow money for ANYTHING, much less to pay for college. This university, like all, I suppose, has become exponentially more expensive in recent years. My generation (husband, sisters, and I) paid for it with athletic/academic scholarships and savings. No undergrad debt for us.

[JanetC]

 She (we?) would graduate with >$200,000 in student loans

 

It is "we" - for that amount of loan you would either be getting a parent loan or the parent would have to be a cosigner. Another vote to drop #3.

 

[fourisenough]

I'm glad we can all agree that #3 is ridiculous. I've been having panic attacks about that much debt. That's NOT our style at all.

 

I think it has been helpful for DD to read all the thoughtful replies about the value and flexibility of a BSN + NP or CRNA. Thanks for sharing your experiences.

 

To address a few questions: yes, both 1 & 2 are guaranteed spots in the nursing school, provided she maintains min. gpa. She will be going in with about 28 AP credits to each school, so should have no trouble graduating in 4 years even as an athlete. Yes, she plans to swim all four years. Both coaches have nursing students on their rosters now and, somehow, they make it work. It is probably helpful to understand that throughout high school, she has trained 9 times per week (about 20 hours), plus commuted about 12 hours per week to/from the pool, all while attending B & M high school. She is used to a crazy intense schedule.

[Sunshine State Sue]

Yes, you read signature correctly. But I'm confused by your question re: extended family's debt. Relevance? My dad graduated in 1960. His final semester cost something like $300 plus gas/oil to commute from his family's farm 20 miles away! They didn't borrow money for ANYTHING, much less to pay for college. This university, like all, I suppose, has become exponentially more expensive in recent years. My generation (husband, sisters, and I) paid for it with athletic/academic scholarships and savings. No undergrad debt for us.

No one in your family who attended school #3 took on that kind of debt.  Maybe if y'all did, and knew that it was manageable, it would make more sense to me that you would even consider taking on that kind of debt. 

 

I wouldn't even consider that kind of debt.

 

OTOH, I can understand the alum appeal.  7/8 of my siblings attended Northwestern.  I think we'd all have loved more of our children to attend. Only 3/19 applied.  Only 1 was accepted.  She graduated last year. :thumbup1:

 

Best of luck with your decision. 

[ocelotmom]

I really can't see #3 being practical, as there are incredibly inexpensive routes to NP available.

 

My daughter is in a 4 year nursing program and I know how much she studies. She is involved in school activities but if she added in a sport she would have to drop everything else. Is your daughter going to stick with swimming for 4 years?

 

This is an important consideration. Nursing school may not allow time for sports. It's not just that there's a lot of studying, which can generally be worked into free time - clinicals take up a lot of time, and likely won't have particularly flexible scheduling.

 

If swimming is important, for personal or scholarship reasons, be sure to talk to the nursing and swimming programs to figure out how feasible it would be. It's possible that another path would be better. For example, completing all prerequisites as part of some other degree, then doing a nursing program after graduation. There are accelerated programs for students who already have degrees that take 12-18 months, or Master's Entry NP programs (these are controversial, because part of the reason NP programs have fairly low clinical hour requirements is that it was intended that students would already have clinical experience as nurses. But they are an option).

 

BSN and then either N.P. or P.A. after graduation (possibly with employer tuition reimbursement to help pay for it).

 

This is another good point. BSN doesn't close the door for PA if she decides to go that route - it will meet most or all of the prerequisite requirements for a master's-entry PA program, especially if she chooses higher level classes in the science classes if it's an option.

 

Don't be too impressed by a 100% NCLEX pass rate in itself. What that most likely means is that they don't let anyone graduate who isn't basically assured of passing the NCLEX. Which isn't a bad thing (they shouldn't be graduating anyone without the requisite knowledge), but doesn't necessarily indicate that the program is doing an excellent job preparing students. I mean, it's theoretically possible that the program does a horrible job preparing students, and the only students who manage to graduate are those who are excellent self-studiers and strong test takers.

 

Also look at the number of graduates. 1 person failing will disproportionately affect the score of a small program, and 1 person failing may mean that person scheduled the test on a day they ended up having the flu.

 

Rates below say 85-90% would concern me. Above 95% is pretty much all equal in my book. (Taking into account the size of the program)

Edited April 21, 2016 by ocelotmom