Mean doctors and nice nurses: It’s time to change our brand

Mean doctors and nice nurses: Its time to change our brand

In my hospital’s preoperative area, upright on her bed, sat an unhappy middle-aged lady who needed an operation to treat complications from her previous bariatric surgery.  She hadn’t lost weight and clearly was feeling discouraged about practically everything.  She was physically uncomfortable, couldn’t even keep down her own saliva because her lower esophagus was obstructed, and was in tears.

As her anesthesiologist, I came to evaluate her prior to surgery.  In fairly short order, I got her a tissue and a warm blanket, listened to her tale of woe, and finished my pre-anesthetic examination.  Nothing special.  At the end, she said,  “You’re so nice.  Were you a nurse before you were a doctor?”

Ouch.

No, I told her, I wasn’t.  Never a nurse; always a doctor.  She looked surprised.

And that little narrative may help to explain why we (physicians as a group) are having so much trouble with public relations, and  with the onslaught and success of mid-level caregivers who want to practice medicine without a license.  Their PR is better than ours because their PR task is easier:  patients already think mid-level health care personnel, especially nurses, are basically nicer and more sympathetic than we are.

Just look at the recent coverage of Hurricane Sandy.  News reporters on radio, TV, print, and online repeatedly and justly praised the heroic efforts that nurses made during the evacuation of patients from dark, flooded hospitals, and showed photos and video clips of nurses hand-ventilating premature infants.  But not once did I hear a mention of the attending physicians and residents who were no doubt working right alongside the nurses, let alone the respiratory therapists, orderlies, and all the other personnel.  Nurses got all the credit in the public’s view.

Anesthesiologists and nurse anesthetists represent perhaps the most visible part of the physician/mid-level conflict, but other physicians are at risk as well.  The American Academy of Family Physicians (AAFP) has recently made public its opinion that nurse practitioners shouldn’t run medical homes, but the Affordable Care Act supports independent practice for nurse practitioners–including admitting privileges to hospitals–just as it supports independent practice for nurse anesthetists.

The latest unbelievable turn of events is Medicare’s decision in favor of nurse anesthetists practicing interventional pain medicine without physician supervision.  Just so we’re clear, this means that a nurse anesthetist with no special qualification other than Medicare’s blessing can bill Medicare for performing invasive pain management procedures that physicians ordinarily train to do with four years of medical school, at least four years of residency, and a fellowship.  These are procedures so risky that my hospital wouldn’t consider me qualified to do them despite my MD degree and anesthesiology residency, because I haven’t taken advanced training in interventional pain management.

What are we going to do to turn around this public perception that doctors are curt, mean, and unsympathetic? And that nurses are always better, kinder, and maybe even smarter?  And can do everything doctors can do, just as well?

Some physicians believe that patients’ opinion of physicians can only be changed one encounter at a time.  I hope this patient thinks better of physicians after meeting me, though the next encounter she has with a physician who hasn’t quite enough time and patience could certainly reverse her attitude.

Maybe, however, we need to take a cue from Madison Avenue and market ourselves better.  The image and the brand are everything today.  And many Americans, while they pay lip service to valuing education, hate to acknowledge that some people know more than others because they have studied harder and longer.  Physicians are perceived as elitist; nurses as nurturing.  The stereotypical TV physician is still an old white guy who’s probably a Republican, while nurses come from all ethnic groups and their unions support Democrats.  Let’s face it: in this dichotomy, nurses are “cooler” and certainly easier to like.

So we need to change the brand.  We don’t need to pretend that “Gray’s Anatomy” has done us any favors. Although the young doctors on that TV show certainly are a diverse group, their behavior isn’t what most of us would view as professional.  But somehow, physicians need to demonstrate these truths to the public:

We are becoming as diverse as many other professions in America today, by gender, ethnicity, or any other measure.

The standard Wednesday afternoon off for the doctor to play golf ended sometime in the 1950s.

We do care about our patients.  Often we wish we had more time to listen, but other patients need our time too.

We worked hard to gain the extensive education we have, and we take pride in using it to care for our patients.

Until Americans become convinced of these facts about their physicians, and like us just as much as they like nurses, we have more work to do.

Karen S. Sibert is an Associate Professor of Anesthesiology, Cedars-Sinai Medical Center.  She blogs at A Penned Point.

Image credit: Shutterstock.com

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  • rebekahroxanna

    Well, I can tell you that doctors can change perceptions by stopping pretending that they are God and their patients are stupid, crazy, malingers, or lazy. I had a 7.5 pound ovarian tumor. Three days before surgery, the surgeon told me that I couldn’t possibly be telling him the truth about what little I was eating because if it were true it was a violation of the law of conservation of matter and energy. (I have three post graduate degrees. I am not stupid. Nor do I lie. I know when something is dreadfully wrong with my body.) One bad apple spoils it for lots of good people.

  • Molly_Rn

    Our roles are different and I believe that, at least in critical care, being called by my first name and my intimate contact with the patient and the daily interaction with their family and friends makes me more approachable. My job is to care for them and if I do so in a caring manner, they know that and respond to me with appreciation and kindness. Technically the job is quite challanging and there is as much science as art, but the art, the act of human kindness goes a long way. Maybe that is why nurses are amongst the most trusted professions. I think we earn that trust.

  • ProudOkie

    And in the process of espousing how physicians are really not mean – the good physician spends half the article lambasting me for the quality care I provide my patients. While trying to be nice, he plays the same old fiddle and denigrates NPs and NAs for their care. “Mid-levels, practice medicine without a license, provide chronic pain management.” Your anger continues to override the point you are trying to make. Throughout your entire article you come off, well……….MEAN!

    “Why are nurses so well liked when all they want to do is everything they aren’t qualified to do and everyone loves them for it! They lie and represent themselves as physicians and every patient they see doesn’t really know how dangerously unprepared they are and………well – it’s finally time to sart using the phrase – BLAH BLAH BLAH!!” Patients, Advanced Practice Nurses, PAs – we are all tired of your whining; especially the anesthesiologists and the AAFP – such expert groups pick fights with the “nice” nurses and think they are going to win. Keep doing what you are doing – a wise man doesn’t have to tell everyone he is wise and a highly skilled professional physician doesn’t have to tell everyone he is highly skilled and professional. If an anesthesiologist medical home and a primary care medical home were meant to be physician led only, you wouldn’t have to continue repeating “PHYSICIAN led” in caps in every article everywhere. The idea should speak for itself – and it doesn’t – because you are not the only ones qualified.

    Your unfounded paranoia and desire to remain top dog blinds you from seeing everything else – you make my job as an FNP who owns a private NP only clinic easy. Quality, compassionate, evidence based care without a blatant disregard for other providers and what they are able to do.

    Let the usual blasts from the primary care physicians begin! Rehash for us! Please!

    • medstudent4

      Go away.

      I’m a medical student and I’ve had far, far, far more training than you. I have an infinitely superior basic science knowledge-base than you (this became abundantly clear when I realized that more than half the NPs and DNPs I’ve interacted with on the wards don’t even know something as simple as the difference between Gram neg. and Gram pos. bacteria — talk about incompetence!) and I have thousands of hours of more clinical training than you (made abundantly clear by the 2 NPs that missed a TIA and thought it was a migraine — wish I had the power to fire them and revoke their licenses). If I’m still deemed unable to practice independently, and I have far better training in medicine than you, why the hell should you be able to short-cut your way into practicing medicine? Let’s be honest here: you’re practicing medicine without a medical license.

      You are a charlatan. An imposter. Someone who was unwilling to put forth any actual effort to become a good clinician (NP and DNP “education” is a joke, LOL). You got greedy and wanted to short-cut your way into good pay. That’s all you are and that’s all your nursing lobby pushes. There is absolutely zero evidence that your outcomes are similar to physicians. You know why? Because there isn’t a single, well-done study assessing this. All we have are idiotic “studies” (I have that in quotations because it seems that NPs and DNPs are so incompetent, they can’t even carry out proper studies without screwing them up) look at useless metrics, like patient satisfaction, as a surrogate for quality of care.

      Keep doing what you’re always doing: not knowing what you don’t know. It’s people like you that scare the crap out of me. Not because I’m worried about my future job (physicians will ALWAYS have a job and patients have shown again and again, in studies, that they prefer seeing physicians over mid-levelss). But because of how much of a danger you are to patients. Because I know the damage and death that you’ll leave behind in your cluelessness. I’ve seen it happen enough times already. Go swindle some innocent patients of their money and health, per usual.

      • Lou

        Wow. I hope you check your ego at the door when you finally start practicing. Please realize that we are all members of a team, hopefully working towards the common goal of taking care of our patients. You may have all sorts of wonderful training, but you need to work on your people skills. Oh, and by the way, I have seen plenty of MDs screw the pooch on diagnoses and treatment.

        • http://www.facebook.com/people/Jason-Simpson/100001631757606 Jason Simpson

          Actually the nurse who posted above him is the one who needs to check her ego at the door.

          • blahblahblah

            Agreed. I can’t believe the gall of nursing midlevels thinking they do the same thing I spent 11+ years of rigorous post-collegiate training in. No way could I have worked part-time during med school or residency. However, I know MANY nurses who work full-time (!) while getting their NP or DNP online! To think that equates to the tens of thousands of hours I’ve (and all other physicians) have dedicated to our craft is not only immensely arrogant and egotistical, it’s also extremely offending to those of who chose the difficult path and didn’t short-cut our way into practicing medicine.

        • blahblahblah

          If you’ve seen “plenty of MDs [with all their years and tens of thousands of hours of clinical training] screw the pooch on diagnoses and treatment,” can you imagine how many more mistakes someone with a fraction of that training will make? It sure as hell is not going to be less than what a physicians makes…

          To NPs/DNPs: check YOUR ego and know your role. You do not have anywhere close to the level of training that physicians get. Hell, you don’t even have anywhere close to the level of training a 3rd year medical student gets! You are the definition of arrogance and ego, thinking that your joke of a degree (that you can get ONLINE, while working full-time as a nurse!!! lol) equates to 11+ years of rigorous post-collegiate medical education.

          Btw, Lou, before you target me, I have excellent people skills. My patients love me and I love taking care of them. Just because I denounce nursing midlevels practicing independently doesn’t mean I have no people skills. There’s absolutely no correlation there.

          • http://pulse.yahoo.com/_3B2VGV3QB7ANRNYHFRB4KKBFWU Debbie

            A person can technically get into medical school with a Bachelors in let’s say History. Meanwhile in order to get a Master’s in Nursing and become an APRN a person will need a Bachelor’s in Nursing. That’s 4 years spent on nursing education that physician’s aren’t getting with their education.

            Most of the online nursing degrees aren’t to become what you think of as an APRN. Most are in nursing education, patient care services etc, in order to prescribe and assess they do have clinical hours etc they have to meet. There it’s impossible to have a fully online APRN degree. Since most nurses are working 3- 12 hour days it is possible to work fulltime and take classes part time to further their education.

            APRNs aren’t looking to do more complicated procedures, they want to perform the routine care they’ve been doing but without having to work under someone. Numerous studies have proven that APRN outcomes are equal or better then physicians. Heck even the IOM endorsed APRNs having an expanded scope of practice.

            You might receive “rigorous post collegiate” training but I’ve seen numerous physicians go into a patient’s room without a stethoscope and document breath and bowel sounds. What kind of patient care is that?

        • Moee

          Time for anger management therapy!

        • http://profile.yahoo.com/Z6QRPLHROJK2W6EBL6ZA6ABT6E Lucia

          Man! And you’re only a medical student. Sounds like another “House” in the making. I think this issue boils down to territory and egos. I’ve seen “nice” doctors and nurses. They both can misdiagnose because they’re human beings, and to err is human. The other problems is that there’s no uniformity in nursing. What’s the difference between an NP, APN, FPN, or an DNP??? The patients don’t have a clue. I don’t believe nurses have taken the easy path to practice medicine and don’t know their motivations for choosing advanced practice (and money isn’t the only motivator). Perhaps the reason they didn’t choose the difficult path may have to do with the prohibitively high cost of medical school.

      • skwerl

        I’m neither a nurse nor a physician, and you may be right in asserting that mid-levels can be dangerous, but so can physicians. A local hospital has had SEVERAL incidents in the past 5-7 years of operating on incorrect body parts. I work in ultrasound and doctors frequently order exams with patient histories that are simply wrong, or once again, on the wrong body part (rule out DVT left leg when it’s the right leg that’s obviously red and swollen).

        Part of the reason doctors seem “mean” is because they often don’t listen. And all the education and training in the world will do you no good when you fail to listen and do not pay attention to detail.

        Patients will be far better off when EVERYONE remembers to leave their egos at home and worry about patient care.

      • http://www.facebook.com/jacqui.maurone Jacqui Ballan

        Oh HELL no. You have GOT to be kidding me.

      • Jen

        Short-cut to good pay? LOL, annually I make more as a staff RN than most of the NPs in my hospital. If you are so concerned about APRN’s scope of practice what type of lobbying in your state have you done? What studies have you participated with? Please tell me you are doing something about this ‘problem’ and not just complaining.

      • ELB

        to medstudent4
        You have to get over your prejudice against nurses in general. I have not had the opportunity to go to grad school to get a Masters to be a CNS, NP, or DNP, but I have continued to self educate by reading and discussing with experts current studies and thinking about all expects of patient care — lab results, radiological results, and putting symptoms together. I have been very fortunate because I have worked with absolute experts in my specialty, and I have been able to keep in touch with experts across the nation, and in some instances the world, about their research. I have had encountered medical students that have had attitudes such as yours, and have had to enlist the head of the department to accomplish actual discussion about a patient’s care.

        You see, I am old, and I put together the skills that I was taught with more modern technology and research. I use my sight, hearing, sense of smell, and understanding of human interaction to assess my patients. Did I take a shortcut to a higher paycheck? Absolutely not! I am a nurse because that is my field — not being a physician. However, unless and until physicians are willing to work in a collegial relationship with nurses, patient care will suffer, and excellence in patient care should be our ultimate goal.

        Actually, as far as studies go, if you examine a study done at Western Reserve University about ten years ago, you will find a comparison between a nurse managed and a physician managed unit. Look up the study — I think you will be surprised.

        I have worked in research for a number of years. The research process is the research process, and in any institution has to be done according to protocol. I take serious umbrage with your comments. I do not know you, but I have to wonder if your attitude is a result of a medical school with an elitist attitude. By the way, I know of several M.D.’s who have mistaken a TIA for a migraine or poor blood sugar control, or worse yet — the patient “faking” their symptoms. I also have seen M.D.’s who have no knowledge of or ignore infection control measures. Let’s face facts. There are always people in every profession who somehow fall through the cracks and actually graduate and get their licenses without learning basic facts. Let’s hope you are not one of these.

      • NotefromFiscalSide

        Wow Mdeities at large! While I agree that there is a difference in the level of care MOST physicians are happy to pass of patients with duties they think are beneath them. Which is almost anything that has to do with humanity. Go ahead and argue and when you start taking temps and weights, I might believe you. You whine you’re overworked and when someone wants to help-for a fraction of what you make-you get mad. So who’s the greedy one?

        And I’ve seen doctors do damage to patients too. Jerks come with all sorts of degrees. They rush. They don’t review charts, they rely on patients to manage their own care. That’s like asking a driver to do all the work on his car and take it to a mechanic who says “Yes, looks good. $5000 please.”

        You know what the call a physician who graduates at the bottom of his class? Doctor. It’s an old joke, but it’s true. Doctors are exposed to a lot of knowledge it doesn’t mean they are able to retain it. That’s a lot to ask of anyone. Notice how there are fewer GP’s out there today then ever? No one wants the job, it’s hard, you have to know stuff. Not just your little pigeon hole.

        Maybe when you’re done passing out pills you’ll figure out why it’s called practicing medicine….practicing because you haven’t figured it out yet. Another old joke. It’s not like fixing a car. What works for one patient doesn’t work for everyone. When healthcare ‘professionals’ notice I use quotes to indicate a lack of belief that the commenter is being professional in his response realize that just because they could afford medical school doesn’t give them the right to act like – like the vocal little student here.

        Doctors are ok with dishing it out, but they really can’t take it. Useless metrics? So now you’re a QA and a doctor, you must know it all! Is there anything you can’t do? Yep. Play nice. Maybe you need a few more years in school and etiquette lessons to boot?

        I guess satisfaction doesn’t matter to you as a student…oh wait, except when you’re the one who’s unsatisfied. But patients vote with their feet and you’re not the only game in town. Sucks doesn’t it?

      • Jennifer

        I would certainly HATE to be treated as a patient by you, or, having to be your work colleague. A medical student with an inflated ego is a ticket to a headache for the department you will be working with. Your “thousands of hours of more clinical training than you(NP)”, really now there little medical student? For a nurse to be NP, it takes quite a few years to get there, a good 5 – 6 years in the field before it can be attempted for many. Add in their student days, I think that their clinical hours will definitely be more than you. Check before your ego gets the better of you.

        There will be competent and not so competend doctors, nurses, physio’s etc everywhere. I have worked with many, and would be working with many with the years to come.

        Hi, the world is waiting for you down here. Don’t underestimate the training some of the nurses undertake to provide effective patient care. I think many doctors and medical students in general don’t know what nurse’s training involve and that the clinical skills and knowledge we can actually accumulate over the years. We read, we ask, and the nice doctors who we work with will also teach. Why would they? The doctors come and teach the nurses? Why waste your time? Smart doctors know that if they work with smart nurses, these smart nurses can help the doctors to provide effective patient care. They know what to look for, what to do, the reasons why we do it and what to expect. That is called knowledge sharing, so that everyone benefits, especially the patient.

        Healthcare is about patient care. The patient is the one we focus on. And their best interest is to have the doctor and the nurse workas a team to provide the care. But if one of the party is dysfunctional due to communication problems or inflated egos, then they will suffer. Please check your ego and leave it at the door when you start. Otherwise, you will get a rude wake up call. And as a nurse, I have no problems approaching the boss to tell them that their new little doctor needs an ego check if the new little doctor has some ego problems.

        • http://www.facebook.com/profile.php?id=655523194 Jeanine Satriano-Pisciotta

          I agree, thought we worked together for the patient! And I have had my fair share of 1st year medical students over 26 years. The one who posted above better get over “I know everything” problem. Those are the one’s that will make a big mistake because they are not willing to learn and listen. Being a good doctor involves skills and the above for the rest of their practices. The day you stop learning is the day you need to hang it up.

      • Molly_Rn

        Did you forget to take your meds this morning? I think so because you are flaming all over the place and if this is your normal behavior, heaven help your future patients.

      • http://www.facebook.com/profile.php?id=662132748 Lata Potturi Schaedler

        You are in for a HUGE surprise once you start practicing. It is very humbling and you do not know 1/10 of what you think you do. You can learn a lot from various team members and their experiences. I hope you lose the ego and the anger – it’s unnecessary and counter productive. I don’t disagree with some of the points you make, but you come across as so nasty that it’s embarrassing to all of us physicians who do know how to play nice with others.

      • Cathy Hoelzer

        Wow, you are something else. Big head already and not yet done with medical school. It is amazing how cruel you sounded in this reply. One day you will have to work within a team and I fear for that team with an attitude like this at such a young age.

    • http://www.facebook.com/people/Jason-Simpson/100001631757606 Jason Simpson

      I know your kind. I was driving thru Norman, Oklahoma about a year ago and saw a clinic advertised alongside I-35 as “Dr Nurse Practitioner, FNP.” Immediately I knew it was a sham, so I did some research. Oklahoma requires all nurse practitioners to have a “collaborative-supervisory” agreement with a physician. I went to the state nursing board website and looked up the “supervising physician” for this particular NP.

      It turns out this nurse-”doctor” was being “supervised” by a general surgeon who works in another city. This surgeon was supposedly checking the work of a family nurse practitioner who liked to call herself doctor, and spent all day doing family medicine type care. Of course a surgeon has no clue as to what the protocols are in family medicine, so I filed a complaint with the state medical board against this charlatan surgeon. He was obviously making a lot of money by having this fake doctor run a factory and churn out patients who were being misled by the nurse.

      After an investigation, the medical board revoked this surgeon’s license, and as a result the NP-run clinic had to shut down because the nurse had lost her “supervision.” I single handedly shut that charlatan nurse down! LMAO

      This is a lesson for everyone. Everytime you see a clinic advertised as being run by a nurse, do some research. Most states require at least some kind of “collaboration” agreement with a physician, and that info is publicly available on state websites. Call that physician up, many times you will find out that they are operating in a sham agreement with the NP to defraud insurance. You can easily expose this without having to spend any money or a lot of hours.

      • ELB

        There are some nurses that can claim the Dr. designation. There are PhD nurses and Doctor of Nursing nurses, so if a nurse cares to use “Dr.” in front of his/her name, it may be legitimate. Just do your homework before you get your dander up.

        • T noble

          you actually need to complete your homework assignment…. There are several states that require NO physician involvment

          • ELB

            T noble needs to realize that I was referring to nurses who choose to use their earned Dr. degrees before their names. All Doctors are not physicians. T noble still needs to do their homework.

      • Molly_Rn

        Actually not quite as bad as a DR. of chiropractic or quackery!

  • meyati

    You’d change your mind if you had some of the nurses that I’ve had. Right now, the nurse with my doctor is very nice. I had a nice OB nurse in 1960, when I was giving birth to a breech baby, another OB USN nurse was really good in 1964. Altogether, I think that I have had about a dozen good/nice nurses since then. I’ve been dropped on the floor-civilian and military hospitals- been told that I need to bring gifts of Navajo jewelry to get good care, and if I complained she’d tell the doctor that I was a trouble maker-consistently weighed in as 15 lbs heavier; I got an appointment with dietitian and doctor 4 same day-then took weight data of both to the clinic manager (the HMO didn’t charge me for dietitian visit and got me a new doctor)- This HMO now includes the actions of the nurse in surveys about a doctor’s care-guess I wasn’t the only one with nurse problems-many don’t seem to know how to start an IV any more-lack of common sense is another factor-I had a hysterectomy, and I sent flowers to those nurses after I got home. I had the D&C at another hospital before that-so I knew how good the nurses were where I had the hysterectomy, maybe 18 good nurses in 50 years. Oh, I breast fed-and was told that I was a nasty person sticking that nasty thing in my poor baby’s mouth.

    • blahblahblah

      When I was a med student and a resident, the biggest bullies in the hospital were nurses. Hands-down. Not even the meanest Ob/Gyn or surgeon comes close to the level of cruelty nurses treat others with (even others in their own profession!). It’s sickening. They do have ridiculously good PR (due to their powerful lobby), so no one outside of the hospital really knows this.

      • http://www.facebook.com/jacqui.maurone Jacqui Ballan

        I’m a nurse and I have to agree with ya there, doc.Nurses can be nasty.I don’t get it either. I always go out of my way to be helpful to the residents/ students and new nurses. None of us, regardless of our role come out of school knowing everything. We are supposed to be a team:(

  • disqus_jqbW8UBYFq

    The healthcare needs of our society dictate a place for both physicians and mid-levels, with physicians retaining their position as clinical experts. Mid-levels need to remember that with authority comes liability; CRNA is NOT equal to an anesthesiologist in training or culpability. It isn’t a contest to see who is smarter, it is about taking care of sick people and preventing well people from getting sick. Let’s function in the spirit of mutual respect; let’s remember we are all going to be patients at some point and the type of provider we would want taking care of us is the type of provider we need to be for our patients. If we followed that rule, we would not need to market ourselves at all.

    • pimptime

      Funny how anesthesiologists always degrade others. The mda group at my facility just took a 40% pay cut! Guess the hospital got tired of paying 650k to ride the couch in the lounge 3 days a week

  • buzzkillersmith

    It has to do with time constraints more than anything else. Most nurses work shifts and get to go home at least sometime close to the end of it, but docs’ time at work is often longer and less predictable. In our clinic the nurses have to stay as long as the docs and get just as irritable, perhaps even more so because they expect to get out on time.

    The psychologists call this fallacy the fundamental attribution error. It is the error that people make when they assume that another person’s behavior is mostly a function of that person’s intrinsic make up when the behavior is actually more a function of the situation the person is in.

  • Caitlin

    Nurses may be more well-liked by patients, but we aren’t always respected by them in the same manner as doctors. I’ve told patients about the importance of a diet change, an exercise, etc. after a surgery or during a procedure, only to have them ignore it until a doctor says it to their face. We may be liked, but we’re not always taken seriously. And on the flip side of your patient’s comment about you being a nurse prior to becoming a doctor… I can’t count how many times a patient has told me, “You seem really smart, are you going to go to med school?”

    As for the hurricane Sandy press… I fully agree that everyone– and not just the nurses– involved in that evacuation deserve to be recognized. But how often do the doctors get credit for a heroic save? The doctor may be the one to perform a procedure or prescribe a medication when something goes wrong for a hospitalized patient, but it’s often the nurse who may have caught an early symptom, say, during a 4am assessment.

    The best bet for either side is to present a united front. It’s not a popularity contest or a years-of-schooling competition; it’s a healthcare *team*.

    • blahblahblah

      Well-said.

      I absolutely agree that it’s a healthcare team. However, when you have dissenting NPs or DNPs who want to take over the role of quaterback (the board-certified physician) instead of playing their role on the team, you will see some clashing. I fully agree with you otherwise.

      PS. God apparently gets most of the credit for saving any patient. I rarely see patients thanking their doctors, nurses, and other staff who’ve worked tirelessly to keep death at bay. It’s a disheartening trend.

      • ydrittmann

        People who do not believe in science still come to the hospital when things go wrong. The doctor helps them with science, God gets the credit.

      • RK

        Let’s do the math on education.

        Medical Doctor: A bachelor’s degree. 4 years of medical school. After medical school, they start doing hands-on care through a residency, which typically lasts 2-4 years. After that, a fellowship of at least a year trains the doctor in a particular specialty. {roughly 11-13 years of education, of which 7-9 relate directly to patient care}

        Doctor of Nursing Practice: A bachelor’s degree in nursing (the last two years are strictly nursing classes, half of which usually involve supervised, direct patient care). Most graduate school programs require that a RN has a minimum of 1 year clinical experience, often referred to as an “externship”. A master’s degree in nursing is typically 2-3 years. If the nurse is in a clinical program, the master’s degree and the hands-on experienced may make the nurse eligible be licensed as a nurse practitioner (NP). Many states are now requiring that a NP obtain a Doctorate in Nursing Practice, which can take an additional 3-4 years. The NP usually continues to work clinically while earning the doctorate. {roughly 9-12 years, of which 7-10 relate directly to patient care}

        So… in summary, a DNP has as much (if not more) clinical training as a medical doctor.

        • mikee60369

          I’m not aware of any residencies that last just 2 years. For primary care (internal medicine, pediatrics, family practice) they are at least 3 years. Some primary care training is 4 years (combined internal medicine and pediatrics). For surgery and aneasthesiology, at a minimum, I believe 5 years. There may be some 1-year fellowships, but most internal medicine subspecialties train for a minimum of 2 years after residency is completed, and pediatrics subspecialties for 3 years.
          So 4 years bachelors, 4 years graduate, 3 years residency, and 2-3 years of fellowship for an MD or DO. Yes, the full 4 years of bachelors and most of the first 2 years of medical school are “book learning.” But that book learning actually IS important.
          During residency, trainees are now limited to working 80 hour weeks. I’m not sure that many nurses put that amount of time in training, but I could certainly be wrong.

  • citizenkarma

    In California strikes for more pay on top of already high salaries and benefits, dominates coverage about nurses, whose collective image seems to be heading south just like it has for teachers. Perceptions about nurses and their role are changing. What is trending up in perception is the value of mid-levels.

  • lol

    instead of you MDs trying to make a point that you are above and beyond anyone and nurses
    that are trying to make a point that they are as capable as MDs to do
    their job, why not think of the patient? the doctors have different
    responsibilities compared to the nurses but both are needed to care for a
    patient. Instead of thinking you are above anyone else, maybe start
    thinking you are EQUAL.RNS & MDS: TONE DOWN YOUR EGOS!!

    • blahblahblah

      We ARE thinking of the patients. That’s why we’re saying that someone with a fraction of the training that a physician gets should not be allowed to practice independently! You know who’s NOT thinking of the patients? The nurse practitioners and nursing lobbies. All they care about is gaining full independence, even though they have less training than a 3rd year medical student, and getting equal pay as board-certified attendings.

      Data shows that nursing midlevels do not ease the burden in rural areas. They flock to the urban areas, just like physicians do. Recent data also shows that prior experience as a nurse doesn’t translate over to being a better NP. You know why? Because NPs practice medicine, not nursing. Generating differentials is completely different than what a floor nurse does. And they want full independence and equal reimbursement when they’ve received less than 25% of the training physicians get. Online degrees + 500 hours of clinical training?! Are you kidding me?! THAT’S clearly not thinking about the patient. THAT’S the definition of arrogance and ego: thinking that 2 years of online training + a few hundred hours of clinical training equals 4 years of med school + 3 years of residency (minimum) and tens of thousands of hours of clinical training.

      Don’t you dare accuse physicians or med students of not thinking of the patients. In this battle, we are the ONLY ones thinking of the patients. It’s pretty ironic since nurses loooove to mouth-off that they’re “patient advocates” (since everyone else in the hospital is trying to kill the patients right?) and are protecting patients from the mean, incompetent doctors!

      PS. I have massive respect for the nurses I work with. They are my eyes and ears. I have absolutely no respect for nursing midlevels who think they can practice independently. I equate them to chiropractors and naturopathic doctors. Stop shortcutting your way into the practice of medicine. You WILL end up killing patients. Seen it multiple times already.

      • LLM139

        Full disclosure: I am a non-clinical healthcare professional, but I hope to never have the displeasure of being treated a physician like you. You take hyperbole to a new level. First, practice better grammar skills. Second, get a grip.

        • blahblahblah

          Sorry for any grammatical errors.

          Which part of my post was hyperbolic? Everything regarding NP training and medical training is accurate. You can get an online DNP degree within 2 years, with no more than 500-1000 hours of clinical training whereas med school + residency provide a rigorous basic science education + tens of thousands of hours of clinical training (it’s estimated that, by the time a physician is done with residency, he/she has over 20,000 hours of clinical training, without even thinking of fellowships).

          NPs are pushing for full-independence and equal pay as physicians who’ve completed training. This is also true and not exaggerated — there are already around 13 states (I could be off on the number) that give nursing midlevels complete independence from physician oversight. Recently, CRNAs gained the ability to practice invasive pain medicine — this normally requires 4 years of med school, 4 years of anesthesiology residency (or another specialty, like PM&R), followed by a minimum of a 1-year long pain fellowship. As the author rightfully mentions, most hospitals will not grant you pain privileges for any training less than that — that’s how risky these procedures are. However, CRNAs have circumvented formal training by using the powerful nursing lobby to convince politicians that a weekend “course” is enough to practice pain medicine safely. I wish I was making this up! The CRNAs I see practicing pain medicine have taken one or two weekend-long courses on managing pain and practicing invasive procedures on mannequins!

          Let me ask you a question: would you let a 3rd year medical student make final decisions on your diagnosis and treatment? Even for minor things? Do you trust that 3rd year student? If you don’t, then logically, you wouldn’t trust someone with lesser training than that, right? By the end of 3rd year, med students have 2000-3000 hours of clinical training already. Most of us follow the same schedule as the intern, for the most part — this means 60-80 hrs/week in the hospital. Feel free to look through the curricula of medical schools and NP/DNP schools. I promise you that you’ll notice the vast difference between medical training and nurse practitioner training. The best NPs/DNPs I work with, who have decades of experience, work at the level of an intern or early PGY2 (second-year resident). None come close to the basic science knowledge nor clinical acumen of even recently graduated attendings. It’s simply because we get more training. It’s really not a hard concept to understand and I’m really not exaggerating anything here.

          So, where exactly was I taking hyperbole to a new level? And simply because you dislike my post, you wouldn’t want to be treated by me? That’s your choice, but as I mentioned in a different post, my patients love me and I love taking care of them. My views on independent practice rights for midlevels in no way affects my clinical acumen or my bedside manner. The fact that you think it does suggests that you don’t really understand what being a clinician entails (which is fair enough since you state that you’re not a clinician). And yes, when physicians speak out against this movement toward NP-independence, we ARE speaking out to protect patients. Let’s be honest here: I will never find difficulty finding a job. The job security a physician has in unparalleled and I will always have a good paycheck. So I have no reason to complain or voice out what I’ve been saying due to any worries about losing my job or my paycheck. So, why would I spend the time speaking out against this? Simply because I (and many, many other physicians) do not believe that midlevels (nursing or PAs) do not have the degree of basic science or clinical training to practice independently. We have to go through a minimum of 4 years of med school and 3 years of residency before we’re trusted to make independent decisions. It’s not right so give someone with a fraction of that training the same level of independence and autonomy. The practice of medicine is a privilege, not a right. And it comes with immense responsibility. There’s a reason medical training is so lengthy (and it’s not because we’re masochists!).

          PS. Again, I have nothing against the regular nurses and NPs I work with. I work very well with my team. The ONLY thing I’m opposed to is independent practice by someone who has less formal training than the M3s/M4s that I precept.

          • http://twitter.com/peachygrl Peachy Grl

            MDs take “short courses” too. I’m an advanced certified hyperbaric nurse and I’ve dedicated the last 7 years to wound care and Hyperbarics. My previous wound care experience is nearly 20 years as a home health nurse and also ICU (5 yrs). I frequently have to educate physicians on wounds and what qualifies for hyperbaric treatments to physicians that have taken a weekend or short course in HBO. This can go both ways. I prefer to take a team approach to this, but that starts with acknowledging that we both bring something to the table. I recognize your expertise in medicine, but it seems to me that you are not willing to recognize my expertise in the nursing process and how it may affect the patient and therefore your treatment orders. Perhaps we can start there.

  • mario3

    My observation on the matter is that Surgeons and any other doctors that are in the surgical/procedural side of the house are a bit curt, mean or have poor personability. The medical side of the house has better bedside manners, respectful and see the team (nurses, pharm, OT, PT, Dietitian… etc) as an equal partner in caring for the patients. This is my observation and I have been a Nurse since 1993. I always wonder why nephrologists, pulmonologists have good relationships with my RNs but not with Trauma surgeons, Interventional Rad. Doctors. How is it that the oncologists and hematologists are able to smile and say hi to the staff nurses but the ortho doctors are abrupt in their dealings. This is the same observation I get with an Anesthesiologist and a CRNA.

    There is no contest on who is the best in delivering the same patient care… but to state the obvious, there is a passive contest on who delivers the best care with a human touch and compassion not only to the patients and family but to the environment that surrounds the patient. This passive contest is not between nurses and doctors. It is among the doctors themselves.

  • Suziq38

    FYI: Many of the doctors I visited as a pharmaceutical rep in the 80′s and 90′s played golf on Wednesday afternoons. Not all, but quite a few. I would not dream of having a nurse administer anesthesia on me. I want the anesthesiologist.

  • Michelle_RN

    There has been a severe problem with bad behavior & misperceptions in medicine for quite some time.

    It’s extremely sad to me to see how far the field of medicine has progressed, yet
    how stagnant in one of the most important components… Behavior & teamwork (or lack thereof) on an interdisciplinary level.

    Dr. Sibert and medstudent4 in the comment section try very unconvincingly
    to not appear “mean”; that notion fails on a grandiose level.

    Education and accolades don’t entitle bad behavior. Education and accolades shouldn’t negate common courtesy and respect.

    Trust is earned, not granted.

    Upcoming changes with Obamacare will place an even greater strain on an already heavily fractured fine line.

    Those few individuals whose practice routinely involves bad behavior (who fuel the misconceptions and feelings of inequity) need to be penalized. Patients are not fools; they know and witness these interactions on a daily basis, and they judge accordingly. It’s long overdue that both entities start to work together to heal and move forward.

    And to, medstudent4: when you finally enter the “real world” as a practicing physician: good luck with getting any support whatsoever with that attitude. You are in for a well deserved, rude awakening.

    • http://www.facebook.com/jacqui.maurone Jacqui Ballan

      Word.

  • GuessWho

    As a patient, I must say that I find most of what I have read on this website is disturbing and only serves to reinforce preconceived notions regarding healthcare professionals: they are completely out of touch with the needs of patients, and are more concerned with their own careers than they are with serving any patient. The discussions posted here frequently make reference to the extensive training received by MD(s) as opposed to nurses, how their knowledge is so much more extensive and their understanding of science is so superior. As someone who has studied and assisted with the education of various healthcare professionals I can attest that most of those whom I have encountered absolutely hated having to go through the basic scientific education required of them. These are the people who call or email the night before an orgo or biochem exam saying that they have very little understanding of the material, and these students present an attitude which translates to “I am above this, why can’t I have my degree and get on with real medical training”.

    If you haven’t guessed by now I am an Organic Chemist, one of my Biochemist friends recently was telling me about her difficulties with the medical establishment. She was long ago diagnosed with fibromyalgia, prior to either of us entering college, recently she was sent to psychiatrist because the medical staff at her HMO could not figure out the symptoms she was presenting to make a diagnosis (we both agree that they were probably more concerned with covering their butts) and wanted a psychiatrist to see if they might be psychosomatic in origin. She reports to me that the psychiatrist took a look at her chart and said “Your case seems extremely complex to me, and don’t know where to begin.” Her response was something along the lines of “This seems really simple to me: I am a Type A personality, who has fibromyalgia, I have exacerbated the situation by [things she self-reported indicated on the chart], and depleted, and perhaps ruined the neurological systems responsible for the production of, my cortisol stores, thus leading to the observed pathology.” The psychiatrist blinked and replied that it seems a reasonable explanation and sent her back to her regular MD.
    I have a few friends who are medical doctors whom I long ago gave up trying to talk about the molecular structures of the medications (especially the psychotropics) they prescribe. It seems that MD(s) are frequently happy to take a heuristic approach to medicine “If this doesn’t work then we’ll try this other one….”, meanwhile the patient suffers and may have episodes which could have been avoided by taking more time, and a comprehensive approach to the patient’s condition.

    We understand that you have very little time and are frequently underfunded (NSF grants for academic research have been cut in half in recent years), however, our understanding does nothing for our conditions when we are forced to turn to medicine by the circumstances that present themselves in our lives. I myself refuse to take any medication without being able to draw out the molecule(s), and perform a sci-finder scholar search on it so that I get a basic understanding of its mechanism of action and potential interactions with other medications or pre-existing conditions. More than once I have asked an MD (without them knowing of my scientific background) who wanted to prescribe a medication what the class of molecule structure was only to encounter a blank stare, followed by them picking up a reference. Twice now I have found that they were trying to prescribe something that my medical history should have told them was probably not a good idea. I shudder to think of what some one who has no scientific background might be subjected to in my place.

    That being said, you are all part of team, each of you has a responsibility to work with each other civilly and the discussions posted here indicate that you are frequently incapable of this. No professional likes to have others lord over them the superiority of their training as opposed to their own and in the end it is the patient who suffers in the case of medicine. Am I in anyway qualified to do YOUR job—NO. I recognize that my strong suit is not in “bed-side manner” nor in dealing with things outside the range of my intellectual interests, that is one reason I chose not to pursue a medical career and instead chose pure science. What I do for myself I would not be able to do for others. I recently found an MD who I get along very well with, unfortunately that is not the case with one of his nurses, I told him about it and he shrugged and said “She came with the office.”

    Instead of arguing with each other about who is better, why not work on being more like the old-school doctor who attended my grandparents and would come over to the house on Saturday mornings for a cup of coffee and see them when they became incapable of coming into the office. My grandparents primary care giver was my mother (with assistance from a couple of nurses) who knew she could trust no one else with her parents. Next time you want to degrade nurses by asserting you scientific superiority, why not consider how much of that training you actually retained and use. Who cares if you took Organic Chemistry and Physics with calculus if you can’t even draw out the molecular structure of the medication you are prescribing, or explain in detail the step-by-step mechanism by which it acts inside the body?

    • http://twitter.com/KatenNP Katenm

      thank you, that really was one of the more offensive blogs I have read on the issue–again–for the record, I rarely read a blog by a ‘mid-level’ as disparaging, as ignorant of doctors’ education, craft and skill as I read from MDs. This has to stop. We work together, Dr. Sibert, and if you want collaborative, supportive colleagues, I suggest you find out that we are educated, certified and LICENSED to do what we are doing. We have to explain DAILY to patients and ignorant doctors like YOU who we are, what we do and why we can do what we do. Your attitude is infuriating, and frankly you would probably be happier on that golf course you mention–is it wednesday? go ahead. I would NEVER want to work with you and your ilk.

    • http://www.facebook.com/caddiso Curtis Addison

      I would challenge you to defend the relevance of memorizing the structures of hundreds of medications. Sure it might be helpful to know which drugs contain, for example, a sulfonamide group, but you can find this online in seconds. Unfortunately, one can do very little in clinical practice by working off of a pure science background alone. Most physicians do know the mechanism of action of the drugs they are prescribing. Good physicians have a massive knowledge base which is often unrecognized, especially now that undergraduate degrees are required for admission. There are good physicians and bad ones, just as there are good and bad chemists.

      I understand that the tone of this article has put a number of people off, and it certainly doesn’t reflect my attitude towards other professions. The purpose, I believe, was to provoke some discussion on the need for changing the face of medicine to one that is more positive in the patients’ perspective. This does not reflect a preoccupation with image or self-interest in all physicians. Patients’ perception of, and confidence in their physician play a large role in their decision to seek medical care and compliance with medication regimens. I suggest that readers are more cautious not to take individual experiences and apply them to all physicians. Physicians and medical students are not all the same. These are my individual opinions as a senior medical student with a BSc in chemistry.

  • Charly

    Oh, disappointed by this discussion war between nurses and physicians. Any of them has to master his/ her job because responsibilities are different. They can’t do the same thing as they have different academic background. However, Ethical virtues have to be the same for all healthcare professionals: caring, Empathy, respect, compassion, commitment, impartiality, trustworthiness, benevolence, courage, etc. Who evaluate this? Mostly our clients. And Healthcare Professionals are liked because of all those virtues. I am not saying that practical knowledge is not important; however a well performed surgery appreciation may be easily shadowed by lack of one of the above virtues. Some of the below comments are fully judgemental, and have explicit arrogance; please try to be neutral while you comment. I expected educated people to have a good level of emotional intelligence, and may not lose temper to the level I have seen. I understand it may happen that you are suddened by a different view, but written is different from spoken, at least you have a short time to regulate , control your feeling before you post.
    Then so what to meet our clients (patients needs)?

    Any way what is happening in US is opposite of what is happening in my Country (Rwanda), generally mean nurses and nice Doctors, but not all the time!!!

  • http://twitter.com/sarasteinmd Sara Stein MD

    Commenting only on the doctor brand – we did alot better in terms of being beloved when the heroes were Marcus Welby MD and Dr. Kildare – now we have the images of psycho-House and a few others. Maybe we need a few Doc reality shows – this is a painful and difficult profession that is intellectually and emotionally satisfying, but filled with unimagineable stress and frustration and burnout. The mean doctor attitude is really just self-preservation from all the pain and suffering, the grueling hours and incredible financial stress.

    Nowhere else do you have an awful death, turn around and start taking care of the next person in line as if nothing just happened. As one of my chiefs told me during surgery residency when I offhandedly remarked it was a bad day (meaning bad outcomes) – “there are no bad days in medicine. Every day is the same.” Unfortunately Robo-doc is not a loveable character.

  • lauramitchellrn

    I think a lot of this goes back to how we’re socialized in nursing or medical school. In nursing school, there’s a lot of emphasis on communication: with patients, other nurses, physicians, etc. I can’t speak to what happens in medical school, only what I saw when we had medical students on the unit with us. Some were very good with the patients, others not so much. It’s been my observation that a lot of people who go to medical school know at an early age that this is what they want to do. All their energy is devoted to that goal and things like the humanities and people skills fall by the wayside. So maybe medical curricula needs to be changed to include more communication?

  • justcurious

    It’s interesting after reading the article and comments that there is no mention of PAs. The author speaks of “mid-levels” but only points to NPs. Let’s delve into their education and previous experience. And their acceptance by physicians. And their acceptance by patients.

    • politigal12

      I would guess PAs are not included in too many tirades because PAs have not sought independent practice. There is a place for a variety of providers with differing expertise but I also believe that physician-led practices are the appropriate venue.

      • Jk Fenton

        Well, there are arguements to PA’s as well. There are some seeking independence, however, since they are governed by the AMA it probably won’t happen. Also, many PA programs are only certificate programs…I know of one at one of the best medical schools, that is only a certificate and the only thing they need is an associates degree…and no practice experience…. This is exactly why I did not go the PA route…the point here is not about each degree and degrading people is that we all have our place. I don’t agree with much to do about nursing admins, which are now requiring a DNP (what even is that degree (and I am a nurse))…to become a Nurse Practitioner…at that point you mineswell go to medical school…
        Regardless, the lack of respect is amazing here on both sides…EXACTLY why I no longer practice…I couldn’t take being BEAT UP daily by disrespectful residents and Attendings (who missed a ton by the way, and we (the NPs) caught critical diagnosis requiring immediate surgery etc) who felt they were superior…we are a team…but unfortunately these posts prove that is not the case…and the real thoughts about our field and nursing in general…

  • Dave Mittman, PA, DFAAPA

    Honestly, I am not sure way you are saying in this? Are you saying nurses care more about people than physicians? I think that’s silly. Are you saying that NPs and PAs and I guess CRNAs are out to take your money which in my humble opinion much of this essay is about, you are also off base. Most of us “midlevels” work for/with/in partnership with physicians, and make them much money I might add. If you mean to say that after 35 years as a PA I don’t know how to provide much of the primary care my PA and NP colleagues provide every day to millions of people, maybe it’s time you looked at the evidence and stop listening to urban legends. Study the studies, or allow us to take competency tests and if we are good enough, we are good enough. I am surprised you did not say “we don’t know what we don’t know”? OR possibly you don’t really know what we know and there is more than one way to learn? I know, alas and sadly when we learn, we are encroaching on holy ground.
    Sorry, once we buy Harrison’s you can’t stoop us. So the system is broken and instead of looking at how you can make it better, you look at other professionals and think we want to practice medicine without a license. As a PA I do not. I do practice medicine-always have. It never was nursing, never was OT, PT or pharmacy. And I have always had a license to practice it. It has been hanging on my wall for decades. In fact PAs have RAN the Boards of Medicine in a few states, North Carolina being one. If we can run the Board of Medicine (not the PA Board of Medicine-but the whole chinchilla) then I guess we practice it. Yes, I need a physician to be associated with but that’s OK. So please enlighten me as to why you think I don’t practice medicine?
    Lastly, I am so sorry for sounding like a jerk, but everything I do is at the highest level, not the middle. I am not a “midlevel”And who is a “low level” clinician?
    I hope you did not use these words as to be hurtful or negative but in many ways please realize they are as they stratify an already poor system that we all agree needs to work better as a team. Please realize the times have changed. You now get to share medicine, not own it. PAs own it also. We practice it too. I can’t speak for CRNAs or NPs but many of them would agree they do too. And now you get to privilege to share it with some great people who provide very high level care and are not trying to do anything to you but be able to provide that care to patients.
    Maybe that’s what the patient was noticing.
    Dave Mittman, PA, DFAAPA

    • http://twitter.com/KatenNP Katenm

      100% correct Dave! when are we going to take these bloggers to task for misrepresenting our education, certifications, competencies, LICENSES etc? How dare they write this? and expect us to work with them. Unbelievable.

  • http://www.facebook.com/becki.mcguinness Becki Mc Guinness

    Apart from nice doctors and nurses, I do think a small percentage of both nurses and doctors can be mean at times and if anything nurses can be bitchy and gossip at the nurses station. Going through my cancer treatment I’ve seen some not all disrespectful staff especially to the older generation. Not all staff are like this though just some.

  • http://www.facebook.com/ed.mathes Ed Mathes

    All of you just need to grow up, stop tooting your own horns, check your egos at the door and LEARN HOW TO WORK TOGETHER to take care of PEOPEL… YOUR mother, father,m sirster, aunt, uncle, cousin, son, daughter…..
    PAs and NPs are here to stay. Live with it.
    Doctors, I challenge you to get along without nurses…. won’t happen.
    And, oh, by the way, as a “mid-level provider”…. and I guess that means, to quote a NY Times artile (or was it US News?) from the late 60′s… “Less than a doctor, more than a nurse”…. I do not provide a mid-level of care. Nor do my colleagues.
    So, rather than bellyaching about how much better your education is over mine, how bad PAs and NPs are for our nation’s health, how we are developing a 2-tiered system of health care, with the doctors at the upper tier of course….WORK TOGETHER to provide the best care you can.
    Everything else is either smoke, politics, or money.

    • T noble

      Thank you and amen

  • militarymedical

    I’m confused as to whether this is a whining monologue about encroachment into MD territory by others perceived by the author as inferior (I shudder to think how she views DOs) or a poor-pitiful-me message that the Big Bad Media is unfair to doctors and their actual, halo-covered natures. I mean, really. First of all, if there were not a vacuum of service, there would be no one filling it. There is a real (not perceived) shortfall of ALL health care professionals, especially FPs, and that is where NPs and PAs shine: basic provision of screenings and maintenance health care for uncomplicated acute and chronic diseases and injuries.
    MDs are not immune from stupidity, ignorance, snoozing through basic classes (I have an old textbook, “Anesthesia For The Uninterested” to prove it, with plenty of references to and photos of the Ether Bunny), malpractice and medical mayhem. It was an anesthesiologist, surgeon and resident at Walter Reed who killed a 16 year old girl during a “routine” T&A about a decade ago – not a CRNA and RNs who would have been performing the duties at root cause of her death, had the procedure been performed at a non-teaching medical treatment facility.
    I agree that online advanced degrees in clinical fields are largely a joke, and I condemn the ANA, NLN and other professional nursing organizations for promoting them. I also decry “degree creep,” when a masters degree becomes required for entry-level positions simply because it “looks better” and is a salary negotiation tool. But don’t tell me there aren’t as many physicians in it for the big bucks as for the personal gratification. After over forty years in the field, I know that is not so.
    The comments below from those who are NOT in the health care professions are the ones to be regarded most seriously, I believe, if we are to progress from the current quarrelsome situation at all. Their message seems to be: get over yourselves, you’re not all that, and give us the best care possible.

  • Jk Fenton

    Hi. Having been an acute care NP, ICU RN as well as being raised by a prominent physician I really think this post is harsh on both sides.

    I went to nursing school because of the belief years ago from a conservative father that’s what girls did…went back and got my masters degree (not online) but at the number 1 school of nursing on the country. I was led to believe from my father that nurses were well respected and taught him much in residency and fellowship, however this negative banter has been present throughout my career. From nursing instructors, who would say negative comments about MDs, which I loudly objected to, to MDs and residents with huge egos. It really was so sickening I finally left my position because the MDs I worked with were patronizing and degrading to RNs. I had worked previously with MDs who were supportive, realized how an NP could help and grow their surgical practice and was given much freedom.

    I am no longer in this profession because of these conversations and being treated terribly. BTW I was paid less than an RN and worked over 70 hours a week! So I have no idea who thinks we get paid as much as an MD please get your facts straight. If you added up my hours, I barely received minimum wage. I personally was not comfortable practicing independently only because I always think you should have a sounding board for ideas and treatments…and honestly if I wanted that I felt I should go back to medical school. But my job was valuable brought in a ton of revenue to my neurosurgeons and yes I did many procedures (well I might add) and billed out over a quarter million a year (as do many first assists) yet I was paid less than an RN?? I think we all have a place and with Obamacare (that the AMA I might add did not use their power to STOP) hurts MDs more and I sense you are fearing of your jobs…there aren’t enough family practice docs to practice and they will use NPs and CRNAs to cut costs. Do I agree no. But bashing each other is absurd and unnecessary be adults and grow up!!

    I think categorizing mid levels as getting their degrees “online” is spiteful and wrong. Yes, I agree there are some terrible mid levels, but there are equally as bad MDs, I have seen them myself. You cannot make blanket statements about ones profession! It’s unfair to both parties.

    • ELB

      As I have said for years, until and unless doctors and nurses collaborate, patient care will suffer. The arguments between professions seem to be a self valuation process. We all learn as we practice, and how much better would patient care be if there were more cooperation between M.D.’s, D.O.’s, CNM’s, N.P.’s, and R.N.’s? In my experience, the various levels of nurses do collaborate, and most family practice physicians also seek information from nurses.

      Another factor is that there are fewer repercussions for doctors who are unpleasant to patients and other medical associated professionals than there are for nurses. Thus, nurses may act in a more friendly way that their work load and patient acuity would predict that they would.

  • ELB

    Physicians may start by not assuming every problem they can not find lab or radiology evidence for is psychological. I have personally been a victim of this, and found myself on an operating table for “emergency” surgery less than a year after a doctor told me that I had to find a better way of getting off work than to fake my symptoms. It was the beginning of my problem, and could have been treated then, if the doctors had not been so myopic.

    As a nurse, I have found it necessary to absolutely aggravate doctors about symptoms that they were considering “psychologically produced”. I was on target every time.

    I realize that there are psychosomatic problems in reality, but do not hide behind that diagnosis when you haven’t considered that the patient is really experiencing a physical problem.

    • MeredithKendall

      Arg, psychosomatic. Label often given to women and people with psych diagnoses (though the psych crowd also get the “drug-seeker” label with high frequency). Thank you, Freud.

      There is some misinformation on how that manifests. Somatization is more frequent in women in cultures where it is inexplicably taboo to report emotions that aren’t happy. The physical complaints, though, are often symptoms of Major Depression – develop a strong relationship, and the person sitting across from you might admit suicide ideation.

      As for us Western European folk, the psychiatric disorder taboo is real but not to the extent of other cultures. If a Westerner is reporting pain, chances of a somatoform disorder are low. It is okay for us to express depression and the like with specific verbal descriptions of emotions experienced, and it’s okay for us to ask for help from atleast a support group or something. We’re not alone in our pain, and our brains don’t necessarily resort to

      That isn’t to say that women in other cultures don’t experience physical pain (no crap!) and that somatoform disorders don’t exist in the West – it’s mostly that the notion of “it’s all in your head” isn’t as common as what many think. Even in the case of vague pain reports, the person may have an existing “physical” condition antagonizing one’s general sense of well-being. I think it’s also worth noting that the brain’s nociception abilities do the job but aren’t always specific – referred pain, anyone?

      Soapbox over. :)

  • http://twitter.com/TheSkinnyWife Cameron Parson

    Did Dr Sibert actually write this article to vent her frustration with not “being liked” as well as nurses? She seems incredulous that nurses are viewed as kinder and even..gasp SMARTER that doctors. That is so insulting. I’ve been an RN for 15 years and was under the impression we were all on the same team, not high schoolers vying to be popular with the patients.

    If patient safety is the concern, Dr Sibert does not come out directly and say it. Where is the data that advanced Practice Nurses have a higher rate of medication error that physicians? Leaves the reader to really wonder if Dr. Sibert is simply unhappy with her own career and perhaps is envious of all those lazy, dumb nurses who never leave their patient’s side during Hurricane Sandy. How dare the local ABC affiliate show an arial shot of their hospital being evacuated and mention the nurses were working hard! Public gratitude!?! That is outrageous!

    I wonder if Dr Sibert even considered that patients have a unique relationship with nurses because, after safety, patient education is at the forefront of their scope of practice. Nurses spend time making sure patients understand their diagnosis that the physican simply does not have more that 5 minutes to explain. Often in the hospital, after the physician rounds, the nurses go right to the bedside and say “Ok, let me explain now what this all means and what coems next”. In the ICU that is what the doctors like us to do, it’s reassuring and compassionate. Nurses do not have ulterior motives as this article suggests.

    Finally, it’s disappointing that she concludes that Obamacare will use Advanced Practice Nurses because the public seems to “like nurses better”.
    Dr Sibert needs to start a blog….and make some new girlfriends. She doesn’t sound happy and is taking it out of nurses. What’s new!

  • http://www.facebook.com/tglander Tom Glander

    I’m a nurse. I work in surgery. I don’t get a lot of respect, or maybe it just seems I don’t. I’m not sure. I am sure however that doctors are highly trained by comparison with nurses and others who aren’t docs. If the level of respect is based on training, then of course I’m getting what I deserve. Less than would be given a surgeon, certainly.

    Even if I am an integral part of the team. Surgery can’t proceed without a circulating nurse. End of story.

    My patients generally ask if I’m a doctor. I correct them each time. Because I’m a guy working in a traditionally female role, that happens.

    Then a female surgeon gets asked if she’s a nurse. That really sucks.

    Perception, obviously, is everything. To correct the “problem” of docs vs. nurses, laid out in the article, perceptions among people not associate with healthcare will need changing. That will take some time, persistence, and dedication.

    Some docs don’t care what others think. They’re the ones who may find a decline in numbers of patients over time. Only time will tell. Good article. And lots of great comments!

  • MeredithKendall

    Oi, profession vs. profession. I get to experience this in my field, which isn’t medical but almost always works with doctors, nurses, and physician assistants in order to provide care. I generally take the let’s all just get along approach, as I have found headbutting to hurt the patient emotionally.

    In terms of doctors and nurses, I’ve noticed a few different things as both a professional and a patient with a chronic disorder. Most nurses are female, and a significant number of doctors are male. Female providers and male providers seem to differ in how they diagnose and treat – women listen for a minute or two and then run through a list of diagnostic criteria with yes/no questions (less true if doing medication management in psych, I think – description is necessary there). Men listen to a narrative with a few prompts prior to giving their recommendation for treatment.

    Having been a patient with chronic issues for almost six years now (OB/GYN – childbirth and the usual maintenance, psychiatry; rheumatology, (formerly) family practice, and internal medicine), I’ve found both approaches can be helpful depending on the skill of the provider. Typically, though, as long as a female provider is warm and friendly, the list method comes off as efficient, knowledgeable, and validating. I think people generally appreciate a female provider – and there are not enough female providers with MDs or DOs.

    I’ve also found that when a provider is good, they’re really good. I’ve met some brilliant doctors, nurses, and physician assistants, all of who have differing perspectives that are beneficial. I have, unfortunately, found that when nurses are bad providers, it’s awful. I have left appointments in tears because a nurse was demeaning. I trust providers as experts, and I don’t care to treat myself – I usually ask questions on the condition, general info on a medication, tips for coping, etc. I have requested specific drugs in the case of working with a psychiatrist, but I work in mental health and it’s accepted that I have a vague idea on medical treatment and etiology theories. Usually the bad doctors are jerks, but it comes off as a more passive dismissive feeling and has not resulted in literal insults.

    Just my experiences, though.

    Medical providers do not have it easy, and I commend all of them for the hard work they do. I do hope there comes a time when the professions are at peace, as I can tell you that warring between education level and curricula does not help the patient.

    Speaking of physician assistants, I noticed someone said it can be a certificate program. Our town’s university has a program that is well-regarded, with medical schools trying to recruit recent graduates. Bachelor’s degree required, two semesters of hard sciences at a university level, a few thousand hours of direct care (can come in the form of psychotherapy, physical therapy, occupational therapy, etc. in addition to medical fields) required prior to admission, year-round coursework, all of which leads to a Master’s degree. I’ve heard it’s pretty brutal as far as physician assistant programs go. It’s interesting to see how states differ in requirements.

  • Zenman

    I’m a Psych NP who is the only prescriber in a 13 person team embedded in a military setting. I was placed there by the chief of psychiatry. Maybe that makes me a “top-level” provider but who cares? Our team just does our job taking care of soldiers.

    Of course NP’s don’t have the training and hours of residency that physicians do. However many physicians have told me much of what they learned is forgotten as it doesn’t apply to their respective speciality. Perhaps physician training should be shortened. Also medical school and residency are poor examples of education excellence. How much do you remember when you’re rushed and dead tired?

    Another thing to consider is that NP’s already have hours of clinical prior to NP school, although that is now changing in some cases. You might argue that my RN clinical experience has no bearing on my NP training but I can argue otherwise. BTW I had 70,000 clinical hours in multiple settings prior to entering NP school. That was 70,700 hours after I got out.

    Before you degrade distance education treat it the same as you do with EBM. Read the evidence; there are many distance educational peer-reviewed journals. Yes, there are good and bad distance education programs just as there are good and bad traditional programs. I have multiple master’s degrees, 2 via the traditional setting and 1 distance education. The clinical is the same…person to person. What was perhaps a little funny is that much of my distance educational material came from well-respected medical schools. Sitting in many traditional classes today is like using a walkman instead of an iPod, very dated and inefficient. Things change…deal with it and try to keep up.

    Guess Who had some good points but consider another one. Do we all really need to be able to draw the molecular structure of our meds? We still are not completely sure how the brain works and how the meds even work. Knowing the molecular structure is fine but in the clinical setting we also have to consider the person and the entire picture. I can explain how Zoloft works (or how we think it works), for example, to my patients. One may find it works very well and the other may have severe side effects and have to DC the med. Yet the molecular structure remains the same.

    I tend to focus on the person who has the disease versus fitting the disease to the patient. The patient with FMS that Guess Who mentions is also not a case that is too complex when you listen to the patient. We all know that’s where you get your diagnosis most of the time.

    I continue to train with one of the most well-known psychologists in the country who, in his early years, studied what made the masters in our field great. Like me, he doesn’t believe in fitting the patient into a certain theory. Like me, he also doesn’t think meds are always the answer. I’ve also studied Chinese and Japanese forms of medicine and worked with fifty different cultures. This has given many ways of looking at a patient. I just do what little I can to help.

    • mikee60369

      70,000 hours? Was that 33 years of 40 hour weeks without any vacation, or 16 years of 80 hour weeks without any vacation?

      • http://www.facebook.com/randall.b.sexton Randall B. Sexton

        Total healthcare years are 41. I lowballed everything.

  • Petes_Pup

    That piece was quite a bit jaded – had the anesthesiologist been a man (with the same exact scenario) – the patient probably wouldn’t have asked that question. The lay public still harbors the notion that women are best at nurturing roles like nursing and mothering. There have been plenty of examples where female docs complain of being called “nurse”, “sweetie”, and the like – while the male orderly was called “Doctor”…. It lies deeper and at a more basic level than the author would have us believe………… men are (generally honestly) perceived as less nurturing than women. Until you get to the root of these gender roles – and their perception at large – changing them in specific professions stands little chance of success……

  • SV

    Let’s go back for a moment and think about the types of people that are attracted to these professions. Many young medical students are not only looking to help people, but also enjoy the added perks of respect and pay. Nurses are often less concerned with pay, but more attracted to the profession because helping someone is rewarding work in and of itself. I don’t think that “marketing” can change who people are, and what they’re working towards.
    But really, who cares? Aren’t we all here to work as a team and improve patient outcomes – together?

  • joyrn

    Well as a nurse I’ve had plenty of patient interaction where they were thrilled with MD and nurses! Recognize the enemy is not the nursing profession but perhaps your predecessors! Stick around and be the change you want to see! Respect the nurse and maybe we’ll put in a good word for ya! ;)

  • Shawn

    if all the PAs, NPs and nurses out there want to practice medicine and do all the work that physicians do, then just go to medical school, complete a residency and stop complaining that you don’t get the same respect from patients or that you’re considered mid-level health care providers.

  • Kash

    I can’t believe how incredibly insecure this article sounds. Boo-hoo, where is the physician’s praise? Have you watched popular medical dramas lately? Considering the only major characters are physicians, doing tasks&interventions registered nurses do on a daily basis, while nurse characters stand in the background, blurred out, filing paperwork and fluffing pillows… it’s about time media portray nurses realistically and with well deserved credit. Otherwise, the general public will continue to maintain the misconceived belief that nurses are merely unskilled, physician’s handmaidens…. thereby further contributing to eventual decrease in quality of patient care (ie: fewer intelligent, enthusiastic, passionate young people entering this fabulous profession and further exacerbating the nursing shortage.) Why doesn’t everyone put their egos aside and be thankful we have the opportunity to be in a position to help others.

  • Megan Parker

    If the likes of ER, Grey’s Anatomy, House, and the other gazillion TV shows glorifying physicians and the medical profession haven’t accomplished your PR goals, then “branding” is not your problem.

  • carolynthomas

    I’m neither a physician nor a nurse. Just a dull-witted patient who somehow managed to survive a heart attack – even though the E.R. doc misdiagnosed my MI (despite classic textbook symptoms) with his pronouncement: “You are in the right demographic for GERD!” before sending me home, feeling supremely embarrassed for having wasted his very valuable time by making a fuss “over nothing”. Perhaps I should have consulted a statistician instead of a “high-level” health care professional with all those undergrad/med school/residency/fellowship/brainiac credentials… I now believe that if we had only Googled my symptoms (central chest pain, nausea, sweating, pain radiating down my left arm), Dr. Google would have surely hit upon the appropriate MI diagnosis. Let’s face it, you don’t need to be a “high-level” to get that, do you?

    Unlike most of your patients, I do have a 30+ year background in the public relations field (corporate, government and not-for-profit sectors) so please allow me to take advantage of that considerable experience here to address Karen’s original point: BRANDING. Until I had to stop working after surviving that heart attack four years ago, I used to teach a PR course in Reputation Management. Those of you turf warriors (particularly you med students!) who are leaving finger-pointing comments here on whose reputation should be/shouldn’t be superior might try Googling “reputation management” for some handy hints on how to get over yourselves. For starters, online troll behaviour is enhanced when you decide to leave your flaming comment under a fake name. Anonymous posters have the luxury of writing things they would likely not say if they had to say them under the straightforward honesty of their real names. Try it next time you leave a comment; I guarantee you will think more carefully about every word you write.

    The original post, and these resulting comments, represent the kind of internal infighting that merely lowers the public’s regard for both groups. Commenters’ choice to engage in open name-calling here is both unfortunate and sadly enlightening. You have much more in common than you seem to acknowledge, and that commonality should be patient care with the rest of your whole health care team. Now smarten up and just get on with it.

  • Kara

    This is laughable. “Mid-level caregivers who want to practice medicine without a license” Yes, that’s what they want…who are you kidding? NPs often have multiple license and board examinations, which are required to practice. If anything NPs are pushing to have more education and residency training because we believe in the work we do with our patients and want to continue to improve. Why so threatened?

  • Cathy Hoelzer

    What a mean and immature blog! It is inaccurate and demeaning to those of us who love our profession as PAs or NPs. I’m 53 years old and have been practicing medicine for the past 11 years and my patients love me and some have actually preferred me over doctors as I’m caring, compassionate and practice wholistic medicine–looking at the patient as a physical, spiritual and emotional being. I didn’t go into medicine to make a lot of money, but to help people who are hurting. So maybe I don’t have as many years of school as you do, but I have many years of living life. I entered PA school at age 40 after have lived a lot of life. In PA school I learned how to become 80% sure of my diagnosis just based on a physical exam and proper history. I often don’t have to order tons of expensive diagnostic tests that doctors are famous for and which drive up health care costs all the time. This has helped me tremendously as I have been practicing bush healthcare (no fancy labs or diagnostic equipment to rely on for a diagnosis) in some of the most rural regions of South Sudan since 2006. And I don’t make money doing this as I’m a volunteer. Maybe if you tried volunteering you might become a bit more compassionate and caring and wouldn’t have to worry about how you use PR to make yourself look better. It would happen naturally because you might actually care about the patient from your heart and not from your pocket.

  • christiansen17

    Familiarity breeds contempt. By working alongside each other, we envy parts of those with whom we spend time and (on some level) admire. Human nature. Fight it. Where you should strive to be superior is in battling that humanistic primal force within that beckons you to fight in any way possible to be on “top”. What you trade for that behavior is the respect you so desperately seek. I am a proud PA since 1993. I have never felt the need to distinguish myself on a tier amongst my physician and nursing colleagues. We are in medicine together and for a reason. The team cannot function without the sum of its parts and no one part is more critical or valuable than the other. Come on guys…didn’t you go to college for four + years??? Aren’t we all better than this? The degree doesn’t define who you are, your character does. Happy Holidays…Prosperous 2013.

  • LastoftheZucchiniFlowers

    Karen – YOU work with CRNAs so I know that YOU KNOW better than to have written this. You were ‘nice’ to the patient you describe likely because you ARE nice. Our personalities do not change when we gain medical credentials. We have both seen horrible bedside manner in doctors/nurses/all manner of health care personnel just as we have seen brilliance and kindness. Don’t oversimplify and know that the enemy is not your midlevel colleague – but the environment which permitted the lunacy which you’ve described “independent pain management’. PS – that’s a hot potato which no sane CRNA will want to touch so I wouldn’t worry about it..And WHERE would you be, and your practice be where it NOT for your CRNA colleagues? Hmmmmm? A bit of trivia for your consideration: the very first NP program was the brainchild of a physician at the University of Colorado in the 60s but non-physician anesthetists date back to the 40s!

  • http://www.facebook.com/meghan.kaminski79 Meghan Kaminski

    Wow, what nurse peed on this Dr’s Wheaties? I am neither nurse nor MD, I am not in the medical field at all. But I have at times been a patient. I think this article is way off base. Especially the Drs/nurses in popular culture assessment. In *most* medical-TV shows I have seen the doctors are portrayed as heroic and have a consuming passion for what they do, often at the expense of their personal lives. I’m not sure how this author got her view of the situation so skewed but I think she has no touch in reality here. As a patient’s perspective we know that Drs are very busy and so may not have time to give as much patient care as nurses and other personal-care medical staff. It doesn’t mean that we think they are “mean”. Just busy professionals trying to do the best they can with the time they can. Perhaps she is just basing her view on her experience of a hand full of patient interactions such as she named in the article. Rather than focusing on negative patient interactions she should focus on the ones who have thanked her for all she has done for them. I’m sure she has had plenty of patients who are grateful for the treatment and care she has shown them.

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