Should I be a nurse or a doctor?

Should I be a nurse or a doctor?

Having been both a nurse and a doctor, most of the questions I get from readers have to do with making the decision between nursing and medicine.  Let’s lay aside for a moment the reality that the fields are totally different and that direct comparisons are useless.

But people ask me all the time, so as a little experiment, I turned to the U.S. Department of Labor (USDOL).  Its employment and training administration arm has an Occupational Information Network, or O*NET.  O*NET has what it calls summary reports that list the tasks, knowledge base, work styles, values, abilities, and interests for a wide variety of jobs.  I looked up the one for registered nurse and compared it to the one for general internist.  Here’s what a comparison of the two reports reveals:

Under “tasks,” the doctor list uses authoritative words:

  • treat
  • prescribe
  • explain
  • manage
  • analyze
  • provide
  • advise

The nurse list uses subordinate words:

  • maintain
  • administer
  • record
  • monitor
  • consult
  • coordinate
  • prepare

This is the USDOL, not me.  Don’t shoot the messenger.  Virtually any member of either field would say that both nurses and doctors do all these things, to a greater or lesser degree, and depending on educational level and specialty.

The entry under “technology” is virtually useless, except for it’s amusement value.  Apparently internists use splinter forceps while nurses use curved hemostats.  Who knew?

Here’s the “knowledge” category:

  • Both doctors and nurses need to know about medicine, dentistry, biology, psychology, and sociology.  Doctors need chemistry.  Nurses need math and computers.  I guess this suggests that the doctor does the experiments but the nurse tells us what it all means.  There could be some profound truth in there, but I doubt the USDOL knows what it is.
  • Doctors need administration and management skills.  Nurses don’t.  I’m ducking now to avoid the rotten tomatoes coming my way from nurse managers and vice presidents for nursing, as well as any nurse who takes care of actual people.
  • Nurses need English language skills but doctors don’t.   Truer, more hilarious words were never spoken.

Then we come to “skills” and “abilities.”  Here’s where the simplistic, incomplete nature of these summary reports really becomes clear, and potentially inflammatory, politically incorrect, and possibly felonious.

Right off the top, the internist needs science, complex problem solving, category flexibility, and active learning.   No laws of hemodynamics or pesky thinking involved in nursing, it seems; no need to “understand the implications of new information for current and future problem solving.”

But nurses have their own skill set that doctors don’t need.  Things like service orientation, coordination, and monitoring.  Like, say, a waiter.  And finally, the kicker: Both nurses and doctors need speech clarity but only nurses need speech recognition.  And if that doesn’t tell the whole story …

There’s a lot more categories with inclusions and omissions along the same vein, but you get the idea.  This post is all in good fun, and I have nothing against the Department of Labor or it’s misguided attempt to give us all occupational information.

But it does make my point that such comparisons are ludicrous and misleading, if not also occasionally humorous.  When someone asks me, “Should I be a nurse or a doctor?” I don’t send them to O*NET.  I send them to their parents, their childhoods, their favorite authors and movies, their passions, what they dream about.  I send them back to their lives to ask the question of themselves.

Shirie Leng, a former nurse, is an anesthesiologist who blogs at medicine for real.

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  • Kristy Sokoloski

    At one time in my life I thought I wanted to be a doctor, but I decided that I want to be a Nurse instead.

  • buzzkillerjsmith

    Chemistry? I need chemistry? I’ve taken enough of it to choke a pig but don’t find it that useful in the practice of medicine. It was required to get through med school.

    • Shirie Leng, MD

      Totally true. And Physics, Calculus and… English.

    • Kristy Sokoloski

      For the General Education class requirements for the Nursing program that I was in I had to take Chemistry as well. Also, had to take Algebra.

    • Dr. Cap

      And calculus. I still have no idea what a derivative is.

      • buzzkillerjsmith

        Definition: A derivative is a limit of the ratio of two quantities, the change in y and the change in x, as the quantities get very small. Like chemistry, It is sometimes taught to premeds in an attempt to clog their brains with useless knowledge.

    • 1SB

      I guess you never take care of people with renal disease, bone disease, thyroid disease, cardiac disease ……
      I’m a nurse and use my chem knowledge all the time.

      • buzzkillerjsmith

        I learned enough chem to be a doctor when I was in high school, except perhaps nucleic acid chemistry.

        I was kind of referring to the stuff I learned in 3.5 years of university chem: chemical thermodynamics and kinetics and then all the quantum mechanics that a guy could want, including molecular orbitals, the Bohr atom, the quantum mechanical model of the hydrogen atom, Schroedinger’s particle in the box, the generalized wave equation, etc. Plus statistical mechanics, a year of organic chemistry from alkanes on up, and memorizing the structure of every stinkin’ amino acid.

        • 1SB

          I don’t disagree but then it would be like not learning anything that doesn’t have “healthcare” in front of its name. Like only taking healthcare economics or healthcare ethics. I also took regular chem inorganic and organic.

          • buzzkillerjsmith


    • Lisa

      I think a lot of college course serve to weed out students who can’t cut it. I know that a course in financial sstems served that purpose in the program I graduated from. Perhaps certain classes serve that purpose for pre med students.

      • buzzkillerjsmith

        No doubt.

  • Ron Smith

    Hi, Shirie.

    Thanks for the article. As a solo practitioner, who employs two wonderful nurse practitioners, there are two things that roundly different between me and the nurse practitioners, nurses, medical assistants, and my great clerical staff.

    These two things have nothing to do with the term ‘assistant.’ Their roles are different, but vital. We function as a team to produce good experiences in providing great medical care. What they do is so important that they participate in monetary practice incentives yearly.

    Because I am the doctor, I’m responsible ultimately for the medical side. I’m the one with the malpractice bullseye painted on the forehead. Seasoned and now in my 32 year of practice, I don’t worry about this. I’ve been both careful and fortunate so far as to never having had a malpractice suit against me.

    But because I’m the business owner, I’m duly responsible for my staff too. I quit rock climbing years ago. I’m careful to consider my personal safety. I have a Georgia firearms carry license. I still do ride a motorcycle, as I’ve been doing since I was thirteen, but I also drive a car in which I am numbers wise more at risk.

    I’m not worried so much about me in this personal safety thing though. My own daughter and son-in-law do some peripheral jobs outside of the daily operations of the practice. What happens to all these people if something happens to me? I feel responsible for more than just a job…what happens to me could jeopardize all my employees.

    Alas, it comes down to even thinking about medical care. Recently I went for an annual checkup. I’m 56 and I’ve been dragging my feet on the colonoscipy thing and I was lightly scolded (again) for that. That will get done in the next few months. I lost about 40+ pounds last year doing one to two hours daily on the treadmill at 3+ miles per hour and 15° incline. Still the right bundle branch block which he found in me, and possibly would have skated over for someone else, prompted him and a cardiologist friend of his to lean toward a stress echo. That’s next week.

    The older I get the more the responsibility of the patients, my employees, my friends, and my family weigh on me. I feel like George Bailey in Its A Wonderful Life sometimes thinking there would be an awful hole in things for all those people. They would go on of course, if the hole sucked me up. That is life.

    Still, the difference between being a nurse or similar ‘assistant’ position and the physician and business owner doesn’t boil down to importance. It simply means that I’m where the buck stops. They go home usually straight up at five PM or before. I carry my laptop where I can access my patients records everywhere, even on vacation.

    My chosen path as solo physician has been rewarding, but alas it is not just about treating patients. They and my staff can back away, but I can’t.

    Warmest regards,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

  • Ladyimacbeth

    I think there will always be part part of me that kicks myself for not having gone to medical school. I took all of the pre-reqs, the chemistry, the math, the hard stuff. I graduated summa cum laude, so it wasn’t lack of grades that decided it for me. I was just tired of school at that time.

    I worked in business for several years before feeling the pull back to the medical field. By, then I was in my thirties and again considered medical school, but the investment it required was more than I was willing to take on – the debt, the years of schooling, etc.

    There is such a wide variety in level of skill and knowledge among nurses. Some are dumber than dirt, some are average intelligence, and some are very bright. You don’t see such a wide variance among physicians. The bar to get in to medical school is obviously a lot higher, so it weeds out those who aren’t too smart. The same cannot be said for nursing, unfortunately. I think getting in to nursing school is now a little more competitive than it used to be due to the shortage of nursing instructors, so maybe this will improve things.

    Even though there’s that small part of me that wishes I had gone to medical school, I think being a nurse was the right decision for me. There have been some amazing opportunities to work in different areas of medicine. I’ve worked on a stroke unit, I’ve worked as a research nurse managing clinical trials, etc. The opportunities are endless.

    • ninguem

      You didn’t miss anything.

  • J Rizzo

    Thanks for the insight!

  • 1SB

    I think the distinction between medicine and nursing is pretty clear if people look at what they feel they are good at or what drives them.

    It is really simple, doctors decide the overall plan of care and nurses make it happen. Do you want to be the CEO or to you want to be middle to upper management?

    My strength is operations. I like making things happen and happen well. I don’t need to be the one to make the diagnosis, but I am very good at determining if that diagnosis make sense. And if it doesn’t, I can logically layout the reasons why and verbalize them.

    I don’t envy the responsibility that doctors have, the buck stops with them. So for me, nursing fits better and I luckily took that path.

  • buzzkillerjsmith

    Being a lunkhead, I have no advice that makes any sense whatsoever, but I do think that starting some MD vs. PA controversy would be ripping good sport. The MD vs. NP stuff has lost some of its thrill.

    May I start?

    PAs suck.

    Oh, no they don’t. MDs suck.

    Feel free to join in at any time.

    • Lisa

      Too funny!

    • RenegadeRN

      Ha ha! Oh Buzz, you rebel rouser!

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