Did you ever give yourself a chance to find out?
Oh, totally agree! I’m sorry if I inadvertently contributed to that sorry notion that nurses are doctors’ handmaidens, or the cheerleader to the quarterback. 
What I was trying to say is that…I’m scared of being the guy the buck stops with. And, even in team medicine, the buck still stops with the MD/DO.
I write 99% of my own orders, and then call the doctor and suggest what we’re going to do, and she signs the orders 98% of the time. 1% of the time, I get an order from the doctor unprompted, usually for labs. The remaining 1% the doctor suggests a change to an order I suggest, and I say yes or why that won’t work and together we come up with an order that we (and the patient) can live with. So it’s not that I don’t make decisions. I make lots and lots of decisions. But there’s always someone else that has to review and sign off on those decisions, and I like that safety net.
Last week, for example, I came back from vacation to find that the patient had lost an entire month’s supply of his blood pressure medicine. Called the pharmacy, they won’t refill it because it’s not due yet and the insurance won’t pay. The patient can’t pay out of pocket, because he’s broke. So now I have a patient with high blood pressure and a history of stroke who, by the way, refuses to call 911 when he’s having chest pains or other serious problems. I internally freak out and call the doctor and explain what’s up. The doctor says, “I don’t know what to do here…” I say, “Doctor, would you like me to increase my visit frequency to three times a week to monitor him more closely until we can get him his medication? I can call you if the blood pressure is elevated, and if that happens, you can try calling in a different ACE inhibitor. Maybe the insurance will go for that.” And the doctor says, “Yes, please! And please educate him about diet and stress reduction and tell him to take it easy.” So I turn it into an order on paper (“Increase skilled nursing visit frequency to three times weekly until lisinopril is refilled. Call MD if BP >160/90. Educate on low sodium diet, non-pharm methods to reduce hypertension including stress reduction and deep breathing, moderate activity.”) I read it back, doctor says “sounds good,” I FAX it, doctor signs it. That’s teamwork.
I really (mostly) told the doctor what we’re going to do. But the doctor had to review it and say yes and sign it, and that makes me feel soooooo much safer, both medically (I know it’s not a horrid idea) and legally (doctor’s orders aren’t a get out of jail free card, but they help a lot.)
Having to go through that would drive some people crazy. Those people should be NPs or PAs or MDs, maybe. But I like the safety net, so I’m keeping my RN.
I’ll opine that it is kind of silly to distinguish between NPs and MDs in general medicine. NPs are just as capable of looking up the answers on the internet as the MDs, and they are generally referred to as Doctor lacking a better title. And the only point in having MDs approve the work of NPs is to satisfy the egos of the MDs.
I may be offending some MDs with that statement, but that would kind of prove my point.
I would try becoming a doctor. Why set yourself for regret ten years from now? Why limit your potential at your peak?
A cousin of mine became a doctor then realized he did not like people, so he became an anesthesiologist.
Trying to become something you don’t necessarily want to be is setting yourself up for regret.
Both my parents are physicians. Dad’s an orthopaedic surgeon, Mum was an anesthetist and later a GP. They’re hugely different people, but both gave me the same advice when I was considering medicine as a career: don’t do it unless you’re sure. Only the ones with unquestioning passion generally make it through med school and residency, and the few that remain burn out rapidly.
Beyond that, given the way the profession is heading and the earning potential for PA-Cs and even NPs, I don’t know why you’d bother becoming an MD.
ETA: I never really thanked my parents for being so honest with me about that career choice. It would have meant a lot to them if I followed them into the profession, but largely because of their advice, I didn’t. I ought to thank them.
No … but I did say I doubt not that I know. 
Seriously though, I may have a high opinion of myself but not so high that I assume that being good at what I do would translate into any other useful job skill set. I cannot imagine being a good lawyer or a good programmer or MBA. Maybe a teacher?
Actually TP there are quite a few differences between MDs and NPs albeit much of it may be due to selection bias. That said with no offense taken.
If a healthcare provider is trying to function by looking up answers on the internet (rather than occasionally researching out specific items) they are not very good at what they do. 99% of what you do you should be able to do out of your in-brain fund of knowledge and judgement.
NPs are in general better at following guidelines; MDs are better at recognizing when an individual falls out of guidelines. MDs are, as a group, more willing to trust their clinical judgement; NPs will usually be more likely to order more tests and refer more often. (More tests and interventions is not better care and can cause more harms than just needless cost.) MDs tend to be more efficient: able to see a higher volume load when required with the same level of patient satisfaction*.
That said those are broad generalizations and the variation within the universe of NPs is huge, even huger than the range among MDs. At our “site” level we every so often discuss our contingency plan for how we would grow our capacity if we get to more volume than we can ramp for with the number of docs we have. The preference right now would be to hire an NP rather than another doc if it was the right one. With many of the brightest students interested in healthcare right now looking at the costs involved in becoming a physician and choosing, on the basis of rational cost-benefit analysis, to go the NP/PA route, not because they did not have the grades for med school but because it is not to them worth the investment, the right one will be less difficult to find than it was in the past.
WhyNot I get what you are saying.
*Looking at patient satisfaction scores across a large group of pediatricians the intuitive presumption that more time per patient would translate to higher patient satisfaction is clearly unfounded. The docs with the highest scores are often among those with the highest volumes: they are able to recognize what the patient concerns are efficiently and address them clearly.
Anecdote: My sister-in-law just became an NP and she’s loving life.
In my experiences as a patient and a caregiver, nurses (including NPs) and doctors tend to have different interactions with patients. Doctors are more data centered and nurses more person centered. Both are incredibly valuable, and completely valid, and figuring out which way of thinking works better for you might be one way to choose between the two career paths.
I find it interesting that becoming a doctor requires a life commitment at a young age. Many doctors started on their goal of getting into medical school when they hit puberty, or even earlier. They spend their youth trying to get into medical school, then making it through medical school, then paying off their loans. In their 30s before they get a chance to breathe, and by that time and after all that effort finding a new path in life wouldn’t seem that practical. That’s all broadly portrayed, but I’m sure you understand what I mean.
Interestingly I’ve met more than a few doctors who would have been good engineers. But not programmers. Trust me, doctors should never be programmers
I’d consider such opinions, but also with a grain of salt (I suspect there have been physicians convinced their profession was going to hell back when Medicare was approved and even before then (when them new-fangled machines, antibiotics and vaccines were interfering with good ol’-time medicine).
There will always be a place for an enthusiastic, dedicated physician despite intrusions from government, insurers, woo-promoters and patients who know better than you because they saw it on the Internet.
What I’d be careful to check out are careers/situations where technology is bound to replace a lot of what current docs do (i.e. in radiology and pathology, but other specialties will be affected to varying degrees) or where the annoyance of documentation and being strapped to electronic devices is just too much. Think about opportunities in developing/employing computer technology/electronic medical records, telemedicine, malpractice avoidance and quality assurance (I know of one anesthesiologist who seems to be having a grand time traveling around the country, speaking to hospital nurses and docs about avoiding mistakes (without having to worry about making his own)). Not as exciting as directly saving lives, but likely to remain dependable sources of employment.
I should also mention that in addition to technology encroaching on some physician jobs, others will face substantially increasing impact via replacement with ancillary personnel like nurse practitioners and physician assistants. Cost considerations will also likely spur more importation of foreign-trained docs.
A lot more money is going to be spent on health care in coming years, but physician income will likely be relatively flat, at best.
Neither should engineers.
How about Renal-Phrenology*, then?
*the science of determining a person’s chracter, mental capacity and well being based on how far they have their head up their ass.
Now that I’ve had time to think about it, I am terrible at making split second decisions and giving clear instructions. I am also inept at understanding unclear instructions. I would be a horrible team leader. Rather than potentially ruining or costing lives, it might be best to reconsider.
I’d much prefer to go “meep” and follow orders, and at least I would be more hands on with the patients. It’s just that performing medical procedures and surgeries is so appealing, even if sitting at a computer and doing paperwork makes up the majority of my time. Unfortunately, my fine motor skills are atrocious, and this may also pose a problem as a nurse doing IVs.
Settling was the wrong word. It seemed like “settling” to me because my original aspiration was to be a doctor/surgeon, and I had to “settle” for nursing because I felt I had no chance. Once I got to know nursing better once I was in college, it started to look appealing. I know that both are amazing careers and would be happy to go into either.
It’s not so much “convince me” as it is, “help me see which one would be better or worse for me”. I feel I have enough of a desire to go into either, but they are both pulling at my arms. It would be a lot easier if I hadn’t already started college. The opinions I have gotten from both sides on here are very helpful.
I am strongly considering NP at this point.
Or work in a GP clinic/office. Or have you considered dialysis? Not all nursing is hospital nursing, and not all doctorin’ is hospital doctorin’. Clinic nurses often draw blood and do IM injections, but it’s rarely in an emergency type high pressure situation. Dialysis nursing might get you the hands on satisfaction you crave (and the target for dialysis needles is usually much bigger than tiny IV sticks.) Or working in a pain pump clinic, where you get to stick needles not in veins, but in these really interesting surgically embedded pumps and fill them full of thrilling scary narcotics! Or wound care - one of my favorite bits of my job is wound care, because I love that feeling of actually accomplishing something I can get my hands on and it looks prettier and healthier when I’m done. 
Or do home health, and do it all, in unpredictable and ever changing ratios.
One of the reasons I got my RN is that I can do so many different jobs in so many different environments with the same piece of paper. Nursing school barely mentions most of them, leaving people with the impression that it’s all Med-Surg, Psych, OB, ICU, ER and Tele. Snooooooore…
Same is true about Dr/MD. Most people who complete the qualification do so because they want to be a doctor, and they need the money, but the opportunities are there (even in the USA, which I know much less about). Research, Sales, Administration, Government, there are heaps of places that are looking for a qualified doctor who wants do to something different.
In my city (duuno about you), there are also unlimited chances to work part-time. Want to work just 4 hours a week (and earn just enough to live)? The standard shift for a casual GP here is 4 hours.
It’s difficult, time consuming, (and expensive in the USA), but it’s a great qualification to have even if you aren’t interested in being a doctor.
Right, and the great thing about clinic doctoring and nursing is that you get shorter days and weekends off. I will look into dialysis nursing. I just tend to be more interested in hospital fields. Same for doctoring. OB nursing is what I’m currently planning on and I’m also very interested in ER, trauma, and OR. How easy is it to move from field to field. Say I start off with your suggestion of dialysis nursing, and then decide a few years down the road I want to go into one of my aforementioned fields?
You seem to be thinking this through well. I’m actually impressed that you’re considering the alternatives to becoming an MD because you’re doing it based on your personal needs, desires, and abilities.
Just having an RN will guarantee you can get high paying jobs. Extending out from there just opens more opportunities. I don’t know, but I would assume it’s easier to move forward and get an NP than to try and become MD down the line.
Good luck Kimbosquee!
Yes and no. Your hours look shorter on paper, and for the vast majority of nurses, they are shorter per shift (12 hour shifts aren’t the norm in clinics, but they are in hospitals) but clinics often expect that you’ll work 5 or 6 days a week instead of only 3 or 4 like hospital nursing. So overall the hours are often longer in clinic, but not so many each day.
There are some really good, dedicated clinic nurses who stay long after the doors are closed, working on case management and getting things in order. I got a call last night at almost 10:00 from one of my favorite clinic nurses. That was a long night, even for her, but it’s not unusual for her to work past 7, even though the clinic closes at 4:30.
So don’t make assumptions, is what I’m saying. Talk hours and overtime at your job interviews.
As long as you have a bachelor’s degree, it’s pretty easy. At least in my city, which has literally hundreds of hospitals and clinics (and tens of thousands of nurses, so the competition is greater, but so are the jobs.) Without a bachelor’s degree, most hospitals won’t even look at you anymore, because they all have or want Magnet Status, which requires (I think) 80% of their RNs to have a Bachelors.
If you want maximum street cred and flexibility, start with ER or ICU. Those nurses have their pick of jobs, in any specialty they care to try out, including things like travel nursing, with one exception I’ll mention in a moment. ER and ICU give you the widest range of experience in technical nursing skills, and they parlay well into OB and Med-Surg and all the rest.
Although I love it and I did it right out of school, I would not suggest home health for a new grad. This field is rough for new grads because we don’t have constant contact with more experienced nurses. If we run into trouble, we have to make a phone call, and maybe leave a message and wait for a call back, and then have to describe the problem as best we can to someone who can’t see or feel what we’re seeing and feeling, and it’s just a really laborious process. Compare that to a clinic or floor where if you are struggling with a Foley, you can literally stick your head outside the door and say, “Hey, a little help here?” and a more experienced nurse will come show you the tricks. Simply knowing what interventions there are, what you can do for a person, comes more slowly in home nursing, because you can’t easily ask someone else. I did it, but it was a lot of work with a lot of independent study that I wasn’t getting paid for, and I honestly don’t recommend it. At four years into home nursing, I feel like I just now am as good a nurse as I would have been a year into nursing somewhere I had peers and mentors on a day to day basis. Nursing school just can’t teach all the important day to day stuff. Home health is best done by experienced RNs.
Home health is also the one area of nursing where working ER or ICU will count against you. We see too many ER or ICU experienced nurses who are just bored out of their minds with home health, or they send too many people to the ER because all the interventions they know require ER equipment. So we’re really hesitant to hire someone with ER or ICU on their resume, unless they’ve already worked successfully in home health for someone else. Or, if you decide you want to try it, tell the interviewer how much you miss being able to do patient education and that you want to develop real nursing relationships with people working with them over time in a holistic way to better their health, not just save lives. The interviewer will eat that up, and probably give you a hug.
Home health and nursing home care are also, very unfairly in my experience, ghettoized in the nursing profession. So for that reason, don’t start there. Get some experience somewhere else first. Too many nurses who can’t get anything else settle for nursing home positions (usually night shift, for which the main job requirement is that you have a pulse and an RN license). Nursing homes have the worst staffing levels and working conditions of all nursing. It’s a real shame, because some of the best nurses I know work in home health and nursing homes, but both are looked down on. :rolleyes:
If you want to go into OB you can become a certified nurse midwife. They basically do all the simple pregnancy care and uncomplicated deliveries but have the doctor to back them up in an emergency. They pretty much get similar pay to other advanced practice nurses (NPs, nurse anesthetists, etc).
Orthos have more regular hours and lose fewer patients.
When I asked my BIL the anesthesiologist what I should be checking out before knee surgery, he phrased it as “Good news. Orthos get sued all the time.” My sister translated. He meant that almost nobody dies from regular ortho surgery. As in dead mean don’t sue.