Has anyone considered becoming a RN, or PNP, instead of an MD?

[guppy3]

After some soul searching last year, I decided to pursue an MD over a MD/PhD because my first priority in finding a career is the ability to work with children daily, and I knew that most MD/PhD's spend the majority of their time in the lab as opposed to the clinic. However, when I started volunteering at a pediatric hospital, I rarely saw the doctors when I was playing with the kids, and it was the nurses who had relationships with their patients that I envied. They deal with the parents, just as the doctors do, but their contact I felt was more extensive. I'm doing an internship this summer that takes me away from my volunteering, and I have never been so miserable! I keep wishing I was back in my home state, hanging out with the kids at the hospital, and I'm so jealous of the other people in my program who were placed in a pedes related lab.

I'm going to be a senior now, and I don't know if all the extra requirements for nursing school will fit in my senior year and I don't want to pay for extra classes after I graduate. Plus, I have been doing so much to prepare for medical school, as we all have, and it would seem like such a waste if I went to nursing school. All the time I spend maintaining a good GPA, research, and studying for the MCAT (maybe this post is coming from frustration with studying lol) and all the money I spent on prep courses and books, I would feel terrible.

Nurses don't have the "Dr" title and don't make as much money, which are shallow considerations but are nonetheless important to me. But they do have more time to raise a family, which is my number one goal in life. I don't know my parents as well as I should because they spent most of their time working doing manual labor. I would hate to repeat this same experience with my children.

I'm so torn. Does anyone have an opinion? Why did you choose an MD over being a nurse? Any resources to help me figure out what to do?

---

Members don't see this ad.

 

[ownage]

$$$$$$$$$$$$ lol


by the way if u like kids so much, u can do babysitting. just saying............

 

[Drrrrrr. Celty]

Nursing and being a doctor is a very different thing. Doctors are trained to do a lot of things and require a lot of studying and act as overseers of most processes. They have a far more practical and extensive knowledge of medicine and its application. Nurses are taught how to do the physical work and monitor and take orders.
Being a nurse in a pediatric clinic might be a very possible option for you. However while you as a nurse can do many things which are general, the doctor can actually treat and understand things you wont. Such as maybe if a kid comes in with a cardio-arrhythmic condition ( I'm bsing here btw), a nurse probably hasn't been trained how to deal with something like this. So the doctor will need to either help or do it.

So if you want a higher specialization in how to help children. Medicine is probably better. If your happy just working with kids in general. Then nursing isn't that bad. Also doctors get paid more.

 

[Perrotfish]

I think you're right that if what you're looking for from your work is patient contact and close interpersonal relationships nursing is probably a better choice. An MD is more of a technical specialty, and for all the lip service schools pay to bedside manner the training (and the requirement for social skills) is not terribly different from engineering. Even amoung those specialties that actually deal with conscious, coherent patients only a small subset of physicians get more than 10 minutes to spend with each individual patient each day. It is also, as you mentioned, a job that definitely has terrible hours at least through residency.

That being said there are reasons to go with the MD. Better job security, better pay, more of a sense of being your own boss, more possible options for your career path, more interesting from an intellectual standpoint, etc. There definitely is a subset of MD jobs that have LOTS of patient contact with children: particularly some Peds specialties and child psych. Also once you get through with residency you can actually have much better hours as a physician than as a nurse, particularly if you're trying to provide for a family. An EM doc can work 3 12 hour shifts a week, spend 4 days/week with his/her family, and pull down more than enough $$ to put everyone through college with no debt. Try that as a nurse. And, finally, there is no amount of $$ you could pay me to do the procedures nurses do daily. When someone poops themselves in a hospital it is beyond price to just be able to tell someone else about it and to walk away.

I have no clear advice, but best of luck with your decision.

 

[NYRN]

After some soul searching last year, I decided to pursue an MD over a MD/PhD because my first priority in finding a career is the ability to work with children daily, and I knew that most MD/PhD's spend the majority of their time in the lab as opposed to the clinic. However, when I started volunteering at a pediatric hospital, I rarely saw the doctors when I was playing with the kids, and it was the nurses who had relationships with their patients that I envied. They deal with the parents, just as the doctors do, but their contact I felt was more extensive. I'm doing an internship this summer that takes me away from my volunteering, and I have never been so miserable! I keep wishing I was back in my home state, hanging out with the kids at the hospital, and I'm so jealous of the other people in my program who were placed in a pedes related lab.

I'm going to be a senior now, and I don't know if all the extra requirements for nursing school will fit in my senior year and I don't want to pay for extra classes after I graduate. Plus, I have been doing so much to prepare for medical school, as we all have, and it would seem like such a waste if I went to nursing school. All the time I spend maintaining a good GPA, research, and studying for the MCAT (maybe this post is coming from frustration with studying lol) and all the money I spent on prep courses and books, I would feel terrible.

Nurses don't have the "Dr" title and don't make as much money, which are shallow considerations but are nonetheless important to me. But they do have more time to raise a family, which is my number one goal in life. I don't know my parents as well as I should because they spent most of their time working doing manual labor. I would hate to repeat this same experience with my children.

I'm so torn. Does anyone have an opinion? Why did you choose an MD over being a nurse? Any resources to help me figure out what to do?

I think your best bet would be to spend some time shadowing a nurse and a physician. There are many misconceptions on here about what nurses do and don't do, and unless you spend a good amount of time with an experienced nurse, you won't really understand what it is they do and if this is something that you can see yourself choosing as a career.

It's just as unfair to say that nurses function like robots and follow orders blindly as it is to say that the doctor spends only 5 minutes with the patient and then forgets about them as soon as they leave the room.

That doctor that spent "5 minutes" in the room will spend countless hours away from the patient planning his/her care that you won't see. That nurse that you think just plays with the kids all day long and nothing more, is working with the physician, and using her clinical judgement in the plan of care to get this child back to health.

Don't go into medicine because you want the title or because you think they make more money. Some nurses make more than some doctors. Sad but true. Don't go into nursing because you think they get to spend all day long at the bedside playing with the children.

Do whatever you can to learn the real deal about each role, and then choose your path. Do not go to nursing school if you do not want to be a nurse. You will be wasting your time.

 

[mvenus929]

I did consider nursing for some time, but I quickly realized that I did not want to be an RN, because I have to understand why something is done, and most nursing don't get that sort of information from the docs. The doctor isn't going to be the one cleaning up the patient, giving medications, etc. The roles are different, and despite what my dad wanted me to do, I wanted to be the leader of the team.

You'll get lots of interaction with children as a pediatrician (whatever specialty), but you're right... you won't be the one to play with themYou'll talk to them, talk to their parents, make decisions, and move on, with maybe a check up or two during the rest of the day (depending on your practice). I don't think it's very fair to say that nurses spend all their time playing with patients either. I volunteered in a pediatric playroom for just over a year, and I very rarely saw the nurses in there interacting with the patients. Of course, those nurses always came off as really mean, so who knows.

 

[NYRN]

I did consider nursing for some time, but I quickly realized that I did not want to be an RN, because I have to understand why something is done, and most nursing don't get that sort of information from the docs. The doctor isn't going to be the one cleaning up the patient, giving medications, etc. The roles are different, and despite what my dad wanted me to do, I wanted to be the leader of the team.

You'll get lots of interaction with children as a pediatrician (whatever specialty), but you're right... you won't be the one to play with themYou'll talk to them, talk to their parents, make decisions, and move on, with maybe a check up or two during the rest of the day (depending on your practice). I don't think it's very fair to say that nurses spend all their time playing with patients either. I volunteered in a pediatric playroom for just over a year, and I very rarely saw the nurses in there interacting with the patients. Of course, those nurses always came off as really mean, so who knows.

Physicians learn about disease in order to diagnose and to formulate the plan of care. Nurses learn about disease and the treatments so that they know how and WHY they are doing the things that the physican wants for the patient. A nurse carrying out orders that he/she doesn't understand would be very dangerous. In reality, although the doctor is making the final decisions, many times the doctors and nurses work together to come up with the plan that will work best for the patient.

If you decide medicine is a better fit for you, that is great. Work hard and you will get there.

 

[morning]

I think you're right that if what you're looking for from your work is patient contact and close interpersonal relationships nursing is probably a better choice. An MD is more of a technical specialty, and for all the lip service schools pay to bedside manner the training (and the requirement for social skills) is not terribly different from engineering. Even amoung those specialties that actually deal with conscious, coherent patients only a small subset of physicians get more than 10 minutes to spend with each individual patient each day. It is also, as you mentioned, a job that definitely has terrible hours at least through residency.

That being said there are reasons to go with the MD. Better job security, better pay, more of a sense of being your own boss, more possible options for your career path, more interesting from an intellectual standpoint, etc. There definitely is a subset of MD jobs that have LOTS of patient contact with children: particularly some Peds specialties and child psych. Also once you get through with residency you can actually have much better hours as a physician than as a nurse, particularly if you're trying to provide for a family. An EM doc can work 3 12 hour shifts a week, spend 4 days/week with his/her family, and pull down more than enough $$ to put everyone through college with no debt. Try that as a nurse. And, finally, there is no amount of $$ you could pay me to do the procedures nurses do daily. When someone poops themselves in a hospital it is beyond price to just be able to tell someone else about it and to walk away.

I have no clear advice, but best of luck with your decision.

I would say that doctors have worse career options since it's more difficult to change specialties, and while they have better job security as full fledged physicians, they have to survive residency first...which is awful job security considering they can fire you and ruin your whole life in a moment.

The OP is looking for a specific thing out of his/her life and personally it sounds to me like they would be happier as a nurse. But it's not like becoming a nurse prevents becoming a doctor, whereas the other way around is basically true considering the amount of time and money you put into becoming a physician. They could get a BSN, which often only takes 12 months as a second degree program, see what happens with that and apply to medical school later if they are not satisfied.

To the OP: I think everyone struggles with whether they're doing the right thing. Or anyone sane and grounded. But going into medical school because you don't want to waste the effort you put into the last couple years of your life is the REAL waste, because it's a long and difficult process and you'll spend many more years slogging through it.

Remember that you'll still be able to take care of and hang out with kids as a physician. You won't get an extended amount of time to take care of them, but you WILL have the satisfaction of knowing you've healed them. If you become a general pediatrician, you could have the same kids as patients from age 1 to age 19+, which is really cool. There are pediatric subspecialties that should allow you to have the same patients for as long as they live in your area. Oncology, genetics, developmental peds, and child neurology come to mind. When parents decide they like a doctor and the doctor is familiar with their child, they don't often switch unless they move. I'm not saying this as someone with a lot of experience in medicine and pediatric subspecialties, but as something I've observed and talked about with people.

 

[NYRN]

double post

 

[Cleavername]

Pharm D isn't bad for the $$$ neither.

 

[mvenus929]

Physicians learn about disease in order to diagnose and to formulate the plan of care. Nurses learn about disease and the treatments so that they know how and WHY they are doing the things that the physican wants for the patient. A nurse carrying out orders that he/she doesn't understand would be very dangerous. In reality, although the doctor is making the final decisions, many times the doctors and nurses work together to come up with the plan that will work best for the patient.

If you decide medicine is a better fit for you, that is great. Work hard and you will get there.

I didn't mean to imply that nurses don't know why they are giving a certain drug. But I work in a hospital, and patients ask me all the time why I'm doing something. The times when I don't brush them off with the scripted answer of 'your doctor wants these tests, but I'm not sure what they're looking for', they ask their nurse while I'm in there, and the nurse, nine times out of ten, can't tell them why the doctor is looking at that test.

Then there are the times when we get weird orders, like a 6 hour glucose tolerance test on an inpatient. We do fasting sugars, then when those are impaired (for some reason other than DKA), we might do a 1 hour glucose tolerance, and then if they fail that, a 3-hour glucose tolerance. I have done a single 6-hour glucose tolerance test on someone in the two years I've worked in a lab setting, and I still can't figure out why the doc made the patient go through that, because the poor kid was starving by the end of it. As it turns out, the unit secretary read the order wrong, but both the nurse and the charge nurse looked it over and saw nothing unusual about ordering a 6 hour glucose tolerance test on a patient. I've had nurses ask me what a certain test looks at (most notably AFP in an adult male), because they couldn't figure it out.

Then, of course, there was the time I had to draw a drug level on a patient, and the nurse called the doctor, and then started demanding to me why I was drawing the blood. I draw it because it was ordered in the computer. She was perfectly fine with me drawing it until she spoke to the doctor.

All of these are instances where nurses have followed orders without knowing why. And it would drive me absolutely insane. Perhaps I just had a bad sampling of nurses, but that's what turned me away. Don't get me wrong... my roommate in college was a nursing student and she was very bright and hard working. Some of my best friends from high school are nursing students or nurses. They're great at it, and I have the utmost respect for them, but it's just not what I want to do for a living.

And I'm starting med school in 5 1/2 weeks, so I think I've worked hard enough for it.

 

[The right Path]

Someone mentioned shadowing as a way to help distinguish what career path is the best fit for you. I think that's a good recommendation. Spend an adequate time shadowing physicians and nurses and specifically ask about the concerns you have.

It amuses me to no end to hear pre-meds discuss what nurses do. You will get more accurate information and actually get a sense of it by shadowing one. And no, working as a CNA doesn't substitute.

Anyway, if patient face time is a top priority value to you, then yes, nurses do have more face time with patients. Unfortunately, depending on how busy the unit is and how staffing is done- this face time can be just brief and perfunctory "in and outs" throughout the day. Not very satisfactory. Also as a nurse (in pediatrics in particular) you have to be the one to peform painful procedures to a population that doesn't totally understand why you're hurting them. My pediatric rotation was more than enough for me to know I would never, never do peds.

I liked the school-nursing rotation. Doing health and safety skits and lessons and Denver development tests for elementary school kids was fun. Unfortunately, in the real world of school nursing, the majority of the work involves tedious case-management and paperwork. In the hospital though, I only had one patient who was well enough to feel like playing. It was my best day there. This kid was special though. 7 years old and newly diagnosed with diabetes. He never even cried when I poked his finger to check his blood sugar or give him insulin. It totally was not the usual experience for me. Sick, scared, suffering, neglected (or some combination) children made me a huge stressball. I can deal with adults and even teenagers, but I dunno, there is just something about sick kids *shudders*. It's just not for everyone. Props to those who do take care of the little guys.

Reading that you enjoy the role of playing with kids made me think of the Child Life Specialists whose job is basically to do just that. They help children and their families cope with the stressors of injury/illness and treatments/recovery, etc. I don't know exactly what their education and training entails. I would imagine it has a background in psych with at least a master's degree. I doubt it pays well, though which, from reading your post, may make this type of career unappealing to you. Anyway, it was just a thought.

Best of luck, in any case.

 

[The right Path]

I didn't mean to imply that nurses don't know why they are giving a certain drug. But I work in a hospital, and patients ask me all the time why I'm doing something. The times when I don't brush them off with the scripted answer of 'your doctor wants these tests, but I'm not sure what they're looking for', they ask their nurse while I'm in there, and the nurse, nine times out of ten, can't tell them why the doctor is looking at that test.

Then there are the times when we get weird orders, like a 6 hour glucose tolerance test on an inpatient. We do fasting sugars, then when those are impaired (for some reason other than DKA), we might do a 1 hour glucose tolerance, and then if they fail that, a 3-hour glucose tolerance. I have done a single 6-hour glucose tolerance test on someone in the two years I've worked in a lab setting, and I still can't figure out why the doc made the patient go through that, because the poor kid was starving by the end of it. As it turns out, the unit secretary read the order wrong, but both the nurse and the charge nurse looked it over and saw nothing unusual about ordering a 6 hour glucose tolerance test on a patient. I've had nurses ask me what a certain test looks at (most notably AFP in an adult male), because they couldn't figure it out.

Then, of course, there was the time I had to draw a drug level on a patient, and the nurse called the doctor, and then started demanding to me why I was drawing the blood. I draw it because it was ordered in the computer. She was perfectly fine with me drawing it until she spoke to the doctor.

All of these are instances where nurses have followed orders without knowing why. And it would drive me absolutely insane. Perhaps I just had a bad sampling of nurses, but that's what turned me away. Don't get me wrong... my roommate in college was a nursing student and she was very bright and hard working. Some of my best friends from high school are nursing students or nurses. They're great at it, and I have the utmost respect for them, but it's just not what I want to do for a living.

And I'm starting med school in 5 1/2 weeks, so I think I've worked hard enough for it.

I can't speak for the scope of knowledge expected of an LVN/LPN since I've never worked with one. But as for RNs:

1. Nurses should ALWAYS know why they are giving anything they are giving. When this is not the case, it is an unacceptable breach of safety.

2. By and large, nurses should understand the whats/hows/whys of their patients' diagnostic tests (labwork, radiology, etc.)

I wouldn't be surprised if a nurse (depending on area of specialty) didn't remember what AFP is for. Honestly, I can't remember an AFP being ordered for any of my patients. I do know that AFP drawn on a pregnant woman for example is to help stratify risk for genetic defects, neural tube defects, possibly multiples- it helps to determine if futher diagnostic workup is warranted (i.e. amnio). Otherwise, it is a cancer-marker (if I remember correctly). The maternal AFP test is more easily remembered (even though I've never worked in OB and did my OB rotation in Spring/2003) because being a mom x2 I've had that test done twice. I don't remember the time-frames of when it should be done, or what is considered the normal range. I guess my point being, is that the knowledge not used falls into obscurity.

I'm not denying that there are nurses out there that are not much better than robots. However, being one and working with dozens of them- with all due respect, I hardly find your examples representative (of RNs anyway). I can't imagine that I work in the Shangi-La of nursing where the rest of the world is so far below our standards, either.

 

[ohgodidonteven]

As an attending, what are your hours usually like? I, too, am curious whether or not being a doctor means you'll have time for things besides work and sleep.

 

[Suenya]

Nursing is probably generally a better career path for you. The money is more than enough to live on (although you'll probably want two incomes if you have a swarm of children), and you'll get generally more time with individual patients to build a relationship.

If you really want to be a doc and still spend more time with patients, have you considered child psych? You have to generally do alot of social work stuff and work with schools/families, but you'll be spending alot more time with each kid than you would in most medical fields.

 

[NickNaylor]

Agreed with others, shadowing in a hospital where all the players interact (read: not in a private office) will give you a better idea of everyone's roles. Reading the threads on these boards, especially in allo, you would think RNs, PAs, and NPs are able to do anything and everything they want. This is categorically not true. NPs do actually have some autonomy (from what I've seen), but are by no means independent. RNs and to a lesser extent PAs do what they are told, with very little attention given to what they think. Some physicians will ask for the RN's/PA's/NP's opinion, but that is by no means a given.

All roles are involved with patient care. The difference is this: do you want to be the one calling the shots (and assume the accompanying responsibility), or do you want to be in a subservient role? If the former, be a MD.

 

[NYRN]

I didn't mean to imply that nurses don't know why they are giving a certain drug. But I work in a hospital, and patients ask me all the time why I'm doing something. The times when I don't brush them off with the scripted answer of 'your doctor wants these tests, but I'm not sure what they're looking for', they ask their nurse while I'm in there, and the nurse, nine times out of ten, can't tell them why the doctor is looking at that test.

Then there are the times when we get weird orders, like a 6 hour glucose tolerance test on an inpatient. We do fasting sugars, then when those are impaired (for some reason other than DKA), we might do a 1 hour glucose tolerance, and then if they fail that, a 3-hour glucose tolerance. I have done a single 6-hour glucose tolerance test on someone in the two years I've worked in a lab setting, and I still can't figure out why the doc made the patient go through that, because the poor kid was starving by the end of it. As it turns out, the unit secretary read the order wrong, but both the nurse and the charge nurse looked it over and saw nothing unusual about ordering a 6 hour glucose tolerance test on a patient. I've had nurses ask me what a certain test looks at (most notably AFP in an adult male), because they couldn't figure it out.

Then, of course, there was the time I had to draw a drug level on a patient, and the nurse called the doctor, and then started demanding to me why I was drawing the blood. I draw it because it was ordered in the computer. She was perfectly fine with me drawing it until she spoke to the doctor.

All of these are instances where nurses have followed orders without knowing why. And it would drive me absolutely insane. Perhaps I just had a bad sampling of nurses, but that's what turned me away. Don't get me wrong... my roommate in college was a nursing student and she was very bright and hard working. Some of my best friends from high school are nursing students or nurses. They're great at it, and I have the utmost respect for them, but it's just not what I want to do for a living.

And I'm starting med school in 5 1/2 weeks, so I think I've worked hard enough for it.

I'm sorry, I must have confused posts with other posters, I thought I was replying to a premed. Congrats on your acceptance to medical school!!

These nurses should not be giving meds or doing things to the patient if they don't understand why they are doing it. We can't be expected to know everything, but it is expected of us legally to understand why we are doing something so no mistakes are made. If we don't know why, we are supposed to find out.

 

[NYRN]

Agreed with others, shadowing in a hospital where all the players interact (read: not in a private office) will give you a better idea of everyone's roles. RNs and to a lesser extent PAs do what they are told, with very little attention given to what they think. Some physicians will ask for the RN's/PA's/NP's opinion, but that is by no means a given.
QUOTE]

I don't find this to be true in most cases, especially in the ICU's. In many ICU's, the nurses make rounds with the doctors. This way, everyone is on the same page, and suggestions can be made by both sides in order to make sure everything runs smoothly. In my experiences, I will offer my input to the docs about the patient, to both attendings and residents, and I have never had any of them refuse to listen to my input. Since they know I am with the patient more than they can be, they will, most of the time, accept my recommendation.

This is one of those things that you will see firsthand when you shadow doctors and nurses. There are many misconceptions on these boards about the role or a doctor and a nurse, and I think unless you see it first hand, you won't really get an idea of how it works in the real world.

 

[nurseawesome]

Physicians learn about disease in order to diagnose and to formulate the plan of care. Nurses learn about disease and the treatments so that they know how and WHY they are doing the things that the physican wants for the patient. A nurse carrying out orders that he/she doesn't understand would be very dangerous. In reality, although the doctor is making the final decisions, many times the doctors and nurses work together to come up with the plan that will work best for the patient.

If you decide medicine is a better fit for you, that is great. Work hard and you will get there.

Exactly right. I am a nursing student, so I have gone back and forth with the RN/MD thing for a long long time.
Here's why I chose MD: More to learn, more to do, more decision making, more respect for your work.
As a nursing student, 50% of knowledge learned is practical (IV starting, charting, .. blah de blah) the other 50% is A/P, pharmacology, and pathology. It's fun, but a HUGE TEASE for someone who is into the science behind the work.
Other bad side nursing: doctors can be jerks when they are tense, and most of them think you're incompetent.

RNs rock though. Don't forget nursing can be an undergrad major for med school. (But that's not nice considering the etiology of the nursing shortage is the shortage of space in nursing programs...)

 

[NickNaylor]

I don't find this to be true in most cases, especially in the ICU's. In many ICU's, the nurses make rounds with the doctors. This way, everyone is on the same page, and suggestions can be made by both sides in order to make sure everything runs smoothly. In my experiences, I will offer my input to the docs about the patient, to both attendings and residents, and I have never had any of them refuse to listen to my input. Since they know I am with the patient more than they can be, they will, most of the time, accept my recommendation.

This is one of those things that you will see firsthand when you shadow doctors and nurses. There are many misconceptions on these boards about the role or a doctor and a nurse, and I think unless you see it first hand, you won't really get an idea of how it works in the real world.

I have seen it firsthand, and the relationship is very much a leader-follower relationship. RNs (or NPs, PAs, etc.) are not expected nor are they equipped to direct a patient's care. They are there to assist the MD with executing his/her orders. This isn't meant to disparage the nursing profession - someone has to do that work, and nurses do a fine job of it. But the specific relationship depends on each individual MD and his/her staff. A cardiologist I know involves her NP substantially in patient care. She will defer to the NP in a lot of cases. Many (in fact, most in my experience) MDs, however, do not accord such deference.

The OP asked about the differences between a MD and RN. I supplied those differences. MDs call the shots, RNs/PAs/NPs do what they're told. Nurses are not idiots. Nurses are not incapable of making clinical judgments. But they have a defined role under the MD. That's the basic premise of the relationship. Is every specific relationship like this? No. But expecting anything else may make for disappointment once the OP gets into a healthcare setting. If he/she wants to be in healthcare, work with people, and not have primary responsibility for a patient's care, he/she should be a RN. If he/she wants to direct treatment, solve clinical "puzzles," and shoulder the responsibility burden for patient care, he should be a MD.

Also, looking at your previous posts, I see you have a history of trying to assert the equality of RNs and MDs, so I'll no longer be looking at this thread before you attack me.

 

[Emikosma]

I'm so torn. Does anyone have an opinion? Why did you choose an MD over being a nurse? Any resources to help me figure out what to do?

I was pretty set on becoming a midwife before I started considering medical school. I am a natural birth advocate, and I work as a doula. If I do go into medicine, I don't think I would want to be an OB/GYN though.

The main reason I am second guessing the CNM route is because I don't want to have to "work under" a doctor, and I've heard that a lot of midwives kind of walk around with a chip on their shoulder because of this.

I think it would drive me crazy to not be able to have final say about one of my patients. I do wonder how much family time I will be giving up going to med school vs. nursing school, and if it is worth it. I really don't know the answer to that yet. As a doctor, even outside of the OB/GYN field, I feel like I might have more influence to actually change the way people think about labor and delivery in this country. As a midwife, I'd be in the middle of the battle, but I wouldn't have the respect and influence that a doctor has.

Honestly, idk- it is a really personal decision, and one that should be made for reasons beyond money and respect, etc.

 

[NYRN]

I have seen it firsthand, and the relationship is very much a leader-follower relationship. RNs (or NPs, PAs, etc.) are not expected nor are they equipped to direct a patient's care. They are there to assist the MD with executing his/her orders. This isn't meant to disparage the nursing profession - someone has to do that work, and nurses do a fine job of it. But the specific relationship depends on each individual MD and his/her staff. A cardiologist I know involves her NP substantially in patient care. She will defer to the NP in a lot of cases. Many (in fact, most in my experience) MDs, however, do not accord such deference.

The OP asked about the differences between a MD and RN. I supplied those differences. MDs call the shots, RNs/PAs/NPs do what they're told. Nurses are not idiots. Nurses are not incapable of making clinical judgments. But they have a defined role under the MD. That's the basic premise of the relationship. Is every specific relationship like this? No. But expecting anything else may make for disappointment once the OP gets into a healthcare setting. If he/she wants to be in healthcare, work with people, and not have primary responsibility for a patient's care, he/she should be a RN. If he/she wants to direct treatment, solve clinical "puzzles," and shoulder the responsibility burden for patient care, he should be a MD.

Also, looking at your previous posts, I see you have a history of trying to assert the equality of RNs and MDs, so I'll no longer be looking at this thread before you attack me.

I'm not attacking anyone. You are the one getting defensive. I agree with what you are saying in that the MD is directing the care. I never disagreed with that. The things I disagree with that I see on these boards is that the nurse blindly follows the MD and has no input as to the plan of care for the patient. That is the type of stereotype that must be put to rest no matter whether the person is going to become an MD or an RN. I don't know how much clinical experience you have, but in my experiences we work as a team with the MD's, and our input is valued by them. I have no hestiation to make a recommendation about patient care to the MD, and in my experiences, have met no resistance to making a recommendation.

I don't know where you are getting this idea that I am saying RN=MD. I do hold the opinion that both roles are very important to patient care, and it has been shown in multiple ways that lack of communication between the two disciplines negatively effects patient care.

 

[JFK90787]

In the ED I volunteer at it feels like the nurses and technicians do all the work lol. There are doctors there, but I feel like many patients only get to see a nurse, and they are just fine with it. I think the doctors are only there to see the occasionally remarkable patient who had a motorcycle accident or something.

As for PAs, I've shadowed an ortho surgeon on his clinicals days for the past year, and I feel like his PA knows as much as the surgeon minus the actual surgery part. Usually, the PA goes in first, does a physical exam, and reports his diagnosis to the doctor. The doctor agrees with him 99% of the time, goes back in the room to give the diagnosis and get all the credit, and recommend surgical options.

 

[mspeedwagon]

I've seen someone give up a seat in medical school to go and pursue a career as a pediatric np first-hand, my sister-in law's sister did this. Initially, we thought she was crazy. She graduated from Harvard, had a relatively high GPA, good MCAT scores, worked at a hospital while applying to medical school (took some additional classes that she aced... anatomy & physiology, microbiology etc.) and then as soon as she got in decided that being a physician was NOT what she wanted to do.

She had a few reasons. The number one was patient contact. If you go into medicine for patient contact, nurses spend far more time with patients than any physicians do. While doctors may worry about the patients for hours on end, their primary focus is to diagnose and treat. The primary focus for nursing is provide care and support. Second, she wanted the flexibility to easily raise a family. Nursing is far superior to being a physician in this respect. Taking time off from nursing is not as complicated as taking time off from medical training (not that the latter can't be done, but it's harder to do). Third, it was important to her to take on little or no debt. She knew many direct-entry nursing programs offered especially strong candidates free rides (and she ultimately got one).

Now, like many on here, at the time we all thought she was nuts. Having just graduated from Harvard with an MD acceptance in hand seemed like a stupid time to re-consider medicine (after all that hard work... wtf). That said, now she has graduated from nursing school and is a pediatric NP. She has no debt and makes a low six figure salary (low 100,000s). She has the most flexibility of any one I know and is ready to get married and start a family. She is exceedingly happy at work because most of her day revolves around patient contact, something that was very important to her. Most of her classmates that went the MD route are still slaving away to finish med school or doing their residency, making nowhere near as much currently (obviously this will change with time; however, she has no debt to pay-off, so it'll take a while before the MDs catch-up, but they will).

Basic moral of the story, it is all what is important to you. I personally want to learn to diagnose and treat illness. I'm not too big on patient contact. Pediatric illness especially appeal to me and as such general peds has some appeal. If I were to specialize, I would want to do emergency medicine (again, the long-term relationship with patients is of little importance to me). Think long and hard about what will make you happy. They are different careers, but you can be successful in both of them. More than anything, it all comes down to what are you going to be happy doing. There are lots of miserable doctors, as there are nurses, out there that really didn't take the time to reflect on this before getting started.

 

[s1lver]

How about a Doctor Nurse? They already have a few of those, right?

 

[zinciest]

As someone else mentioned, your role as a nurse will be dependent on which unit you work in. I know someone who works as a nurse in an ICU, and it is extremely collaborative. I'd imagine that it would be the same story in a PICU. It's true that it's not as academic as medicine, but you can really make it as intellectual as you want. There are Nursing journals, Critical Care Nursing conferences, etc..

I think that there are misconceptions on this site about what nurses do because most pre-meds are not going to shadow a doctor in an ICU. They're mostly going to be exposed to OR nurses and nurses on the medical floor. My non-expert perspective is that it's practically a different world than ICU nursing.

So if you're interested in spending a lot of time with patients, working consistent shifts, and you're not too down on not amassing all of the medical knowledge, it might be something to consider.