What makes a physician's role fundamentally different from a nurse's?

July 6, 2014 1:13 PM

I have to articulate my desire to become a physician, and I'm having trouble explicitly stating my motivations. I work in a hospital and have been shadowing doctors, so I know that they essentially use their understanding of medical science to make diagnoses and come up with a treatment plans. However, I'm curious to know how the "calling" differs between people who want to become physicians, and people who want to become RNs.

(Physicians also deal with time constraints, a system that reimburses procedures over preventive measures, a lot of bureaucratic red tape and endless amounts of paperwork, but every job has drawbacks and not-so-fun aspects.) My love of thinking about abstract scientific problems, meeting people's practical needs, and using my creativity to come up with innovative solutions to problems are my primary motivators. Would really like to hear from healthcare providers in both fields!

posted by sunnychef88 to Education (15 answers total)

My mom was a nurse, and she always says that one of the biggest differences she observed between nurses and doctors was time spent with patients. Nurses get more 1:1 time with patients; doctors have less time with patients. For her, the most fun part of the work was getting to make a concrete difference in a sick patient's day - not just by doing her job well, but by doing it with a smile on her face.

(She also says that nurses have relatively little autonomy and creativity, and doctors tend to have much more - based on your personality description, I bet you'd make a great doctor.)
posted by schroedingersgirl at 1:27 PM on July 6, 2014 [1 favorite]

For some people, it's simply not possible to become a doctor. If you factor in the costs along with the sheer amount of time in training (school, internship, residency) - you are looking at 10 years minimum and hundreds of thousands dollars worth of debt. A nurse is significantly less, a physician's assistant is I believe 5 years. I also wanted to point out that the US is currently having a residency shortage where there are more graduating medical students then there are residency openings. The AMA is expecting this to get worse before it gets better and is calling for educational reform. Don't assume that graduating medical school means you will automatically enter a residency, some people are waiting years before entering the next phase. Also, while their was reform a few years back in terms of working hours, residents still work extremely long hours, usually up to 80 and sometimes up to 24-48 hours straight.

For nurses, I've found that many enjoy the patient aspect and care but hate the lack of respect from providers and some patients. Providers enjoy the respect, being the decision makers, and the money - I've met some excellent providers but the one thing they all have in common is their egos. I think that is a good and bad trait with providers - they are usually great at their job but extremely difficult to work with. Nurses also tend to have a bit more flexibility with career choices while providers are usually locked in to either a location, specialty, or both. Nursing also tends to be viewed as a female role while males are usually assumed to be providers; doctors have much less of a stereotype in the gender roles but nursing is still very much assumed to be a female role. I've seen males get less respect from both staff and patients while having to do more of the labor intensive work in a nursing role. It sucks - but it often forces otherwise good male nurses into other careers due to this.

I wanted to also point out that not all physicians work in patient-centric roles, some providers are research oriented so that may play into your desire for abstract scientific thoughts and innovative solutions. You are also correct that providers deal quite a bit with paperwork, bureaucracy, and never have enough time in the day. Factor in the meaningful use metrics (government standards on things like how many RXs are e-prescriped, tobacco cessations, etc. - hospital administrators are pushing VERY hard on this right now as it directly correlates to government reimbursement, up to 50K I believe for each provider) and the continuing implementation of EMRs, and providers are always expected to be up to speed yesterday. Also, physicians work long hours that never really stop - it can wreck hell on a home life. Affairs, gold diggers, latch key kids - unfortunately, I tend to see more of these with providers then another profession but that just may be me right now. Both careers require continuing education so the learning never stops. That's all I can think of right now.
posted by lpcxa0 at 1:54 PM on July 6, 2014 [2 favorites]

Yikes, I just realized that my comment makes it sound like nurses aren't creative. That is certainly not true - what I meant was that nurses use relatively little creativity in their day-to-day jobs.
posted by schroedingersgirl at 2:25 PM on July 6, 2014 [1 favorite]

This is a little bit of a difficult question since there are as many different ways to be a nurse as there are to be a doctor. An OR circulating nurse, a dialysis nurse, a chemo nurse, an L&D nurse, a med/surg floor nurse, an ICU nurse, a school nurse, and a regular ol' primary care nurse all have very different job descriptions.

Schroedingersgirl is right in that one big difference tends to be the amount of face-to-face time with patients--nurses tend to spend much more time in direct interaction with patients, but that time is mostly spent enacting the plan of care--administering medications, tending to patients' physical/emotional needs, and gathering data to assess their general condition. This can be quite complex and require a lot of clinical judgment and skill. The physicians' job is much more about integrating data from different sources (patient history, physical exam, lab data, etc.) and making an overall plan.

Nurses deal with just as much, if not more, red tape than physicians do--pretty much everything they do has to be documented and charted!
posted by The Elusive Architeuthis at 2:30 PM on July 6, 2014 [1 favorite]

Every single nurse I know became a nurse because they thought they would have a flexible schedule, be able to work anywhere and make good money with a minimum of (re)schooling. Thats worked out better for some than others but, without exception, that's why they went into nursing. None of them dreamed of being a nurse in high school. For most of them it was a second career. Lots of burned out research scientists and newly divorced parents go into nursing.

The doctors I know were focused on medicine as a career early on and really seemed to mainly want two things: helping people and the prestige of being a doctor. They have the opposite of a flexible schedule and it's less of "just a job".
posted by fshgrl at 2:57 PM on July 6, 2014

Note that there is still a gender socialisation component at play here. Nursing, teaching and social work are seen as "helping professions" and are still dominated by women.
posted by DarlingBri at 3:27 PM on July 6, 2014 [2 favorites]

Honestly, with the arrival of the Nurse Practitioner, there's little operational difference between the two, in terms of patient care. Whenever anyone in my family has to make a trip to our PCP, we more often than not end up seeing the NP.
posted by Thorzdad at 4:21 PM on July 6, 2014

I am an RN. I have a bachelor's degree in nursing.

The fundamental difference is that physicians are diagnosticians. A regular Registered Nurse does not diagnose nor do they come up with the plan of medical treatment.

If you are interested in coming up with innovative solutions for people's problems, I wouldn't necessarily recommend nursing. You are limited and cannot come up with treatment plans unless they are nursing measures. There is also little room for using your creativity. There is nothing creative about most jobs in nursing.

Whenever I meet someone who is interested in becoming a nurse or on the fence on becoming a nurse, I almost always advice them to aim higher. If you have the brains I would go for Physician's Assistant or Medical Doctor. Nursing has served me well and allows for plenty of flexibility in my schedule, but if I were smarter and wiser in my youth, I would have aimed higher.

I don't think I would steer my children into medicine. A lot of doctors I know have no time, are overworked, and as you mentioned, have to deal with tons of red tape.
posted by Fairchild at 4:49 PM on July 6, 2014 [6 favorites]

My sister is an NP. Her autonomy varies greatly depending on the setting. Doctors have lots of autonomy.

So, you're female? Pretty sure most men, when asked why they want to be a doctor, will talk about why they want to practice medicine not in comparison to nursing.

If you're a doctor, and once you have some years practicing, you can find opportunities to work more manageable hours. I just had to change doctors when I changed insurance; my old doc worked part-time. New doc is full time, and has somehow managed to set it up so he sees patients for more than 10-15 minutes, which is nice.
posted by theora55 at 5:14 PM on July 6, 2014

Response by poster: Thanks for the feedback, all! I will not be discussing how my motivations differ from those of someone interested in nursing, as there's no need to compare the two professions in the essay I'm writing. It is useful, though, to know in more concrete terms how the scope of a physician's duties as a compassionate "helper" differs from that of other related professions.
posted by sunnychef88 at 5:22 PM on July 6, 2014

Best answer: God damn. I always encounter questions like this before major exams when I'm at my most cynical. Hi. In like 30 hours I'm taking Step 2 and over the last week or so I've drilled over a thousand practice questions that explain pretty well the difference between nurses and folks who went to doctor college.

I'll get to them in a minute, but first I want to talk a little about Kant. That guy, man. They say he knew everything-- at least everything there was to know in the western canon of science circa the late 1700s. Sure, Science hadn't yet split off from philosophy and fractured into a million different sub-fields (hell, most people at the time called it "natural philosophy") but take a moment to wrap your mind around that level of comprehension. Imagine observing any phenomenon and being able to understand it at a mechanistic level, from the macro-economic to the wee beasties. Kant died in 1804. An old professor of mine told me that he was the last person who knew everything.

That hasn't stopped us from trying, though. I hated organic chemistry but I had to take two semesters of it to get into medical school. I sat there and pushed the arrows and had a pretty bad time of things but I didn't fail. I pressed on, and in medical school my biochemistry professor made us memorize all the amino acids and their charges. I sat there and put everything on flash cards and had a pretty bad time of things, but I didn't fail. I pressed on, and my pathophysiology professor showed us all slides of some poor kid with Hartnup disease. The kid's SLC6A19 amino acid transporter was broken and he couldn't absorb neutral amino acids, which made him deficient in tryptophan and all its downstream products. I was starting to get better at medical school by that point so I had an OK time of things and didn't fail. I pressed on, and I hope that when I see some ataxic, trembling infant with this 1 in 30,000 condition, I'll know what it is and how to treat it. I spent two years learning basic medical sciences so that I could not just diagnose but understand the diseases I would one day treat. Those orgo and biochem and pathophys professors all teamed up and tried to give me a mechanistic view of the world.

They failed. There are too many facts in the world now, and however much I aspired to the brilliance of Kant, I still had to look up all that stuff about the amino acid transporters and I couldn't draw you those AAs if you asked me to or push any of their electrons anywhere useful. When I see some infant losing weight and pissing tryptophan, all I'll know is that I need to get out my tablet and find the UpToDate article on Hartnup. I guess that's sufficient for the purposes of a physician but it falls pretty short of the ideal, which according to my philosophy professor hasn't been attainable for 310 years. So I pay USMLEWorld $125 for a 30-day subscription to their question bank and I drill those questions until I've memorized the keywords. Pellagra? Dermatitis, dementia, diarrhea. Wernicke's Encephalopathy? Confusion, ataxia, nystagmus. Cardiac tamponade? Hypotension, JVD, muffled heart sounds.

The difference between this and nursing? We tried to understand it all mechanistically. Maybe we do. at least a little. NPs order a lot more tests than doctors do, and maybe it's because that understanding allows us to diagnose more accurately and treat more effectively using less information and more reason. But it comes at a price. It takes something on the order of seven years and 20,000 hours to train a physician, but only ~5,000h and 3y to train an NP. I've completed only about 10,000 hours by the paper's formula, so maybe there's still time for me.

That's the cynical answer. I'm gonna get some sleep, drill a few more questions tomorrow, take a nine-hour multiple choice exam on Tuesday, and hopefully get back to you with something more optimistic later this week.
posted by The White Hat at 5:38 PM on July 6, 2014 [8 favorites]

It is useful, though, to know in more concrete terms how the scope of a physician's duties as a compassionate "helper" differs from that of other related professions.

I have a rather cynical view of what we are propagandized as being "helping", so you will have to excuse me for a bit. There is kind of an idea that the only authentic form of "helping" is constant one-on-one interaction and nurturing and that other professions are not really authentically helping.

The doctors I know have long-term, ongoing relationships with their patients, even if they're not there at the bedside outside of seeing them during rounds and diagnosis or in the OR. Doctors spend a lot of time figuring out what to do and telling other people to do it after they've figured that out. That's the value they add.
posted by deanc at 6:21 PM on July 6, 2014 [5 favorites]

I am a Registered Nurse but, originally, I wanted to become a surgeon. In my early 20's, I decided that having a life was more important to me than becoming a doctor. I am happy with my choice, but that is really what it came down to. Good luck to you.
posted by Amalie-Suzette at 6:51 PM on July 6, 2014

Trying to think of an analogy for the doctors and nurses on med surgery floor T a hospital and it seems to me that a doctor is to a nurse as an architect is to a builder. The doctor prescribes a treatment plan and the nurse carries out that plan. An architect makes a set of blueprints and the builder constructs the building.
posted by MadMadam at 6:51 PM on July 6, 2014 [1 favorite]

Best answer: I am an RN. I think MadMadam's analogy of doctor:architect::nurse:builder is a pretty good place to start when examining the relationship between the two careers, provided the interconnectedness between the two is recognized.

An architect can design an incredible building that's a marvel of modern engineering, but the builder knows what can actually be constructed given the available materials, the soils report, whether or not it'll be possible to get permits from that grumpy guy at the planning commission, when the foreman's wife is going to have her baby and whether or not he's going to need to leave the job to be with her and what kind of delay that will cause, etc..

Just like the back-and-forth necessary between the architect and the builder, there is, or at least there should be, a great deal of discussion between the doctor and the nurse about the plan of care, taking into account the nurse's intimate knowledge of the patient from her time at the bedside and more nuanced understanding of the day-to-day operations of the hospital, before it's implemented.

In short, the doctor knows science and theory, the nurse knows the patient. Together, they fight crime help the patient.

Also, I am absolutely blown away that so many people believe that nursing is not creative. I use my creative problem-solving skills every single hour of every single shift. Here's a short list from the first half of my shift yesterday: 1. The patient didn't see eye-to-eye with the doctor about meds/treatments/etc., so it was up to me to negotiate a creative way to make the treatment plan happen. 2. I MacGuyvered the unit's label printer when it broke after hours and the support people couldn't be there until the morning; without labels we can't send blood to the lab. 3. I created an appropriate meal for a diabetic out of a regular diet tray when the order was entered wrong and the kitchen closed before the error was discovered. 4. We were out of hot packs, so I made one out of a wet towel and an absorbent bed pad.
posted by jesourie at 2:19 PM on July 7, 2014 [4 favorites]