Hello folks,
Could someone kindly explain to me the difference b/w these two models, and perhaps why one would choose to become a physician rather than a nurse.
Is it simply that a doc does the diagnosing with limited patient care, and the nurse (or NP)does the majority of patient care and interaction?
Thank you.
Wow where to start? I’m an RN in Med school and so far the big difference is how in depth I study Anatomy, cell , embryo ect. It is at a much higher level. It seems to me that as a Nurse I was way involved in Psych/Social aspect of the well being of Patients. Everything seemed to be surrounding fulfilling basic human mental and physical needs while healthy or in Illness. Carry out the medical and nursing care plan. Coordinate care for the Patient with the MD. As far as a Nurse Practioner, well I would think it would be the aspects of the RN expanded into the part of the role of the MD, but not completely, in many instances an MD still steps in when it comes to a NP and PA.
As far as Patient interaction I think you can have a lot of interaction as an MD I want to do rural FP and hope to have more contact with my patients in that setting.
As an RN I found the work occupied a lot of my time and with Hospitals and even Homecare time was short and I did not have a lot of time to spend with Patients. If you are really interested in both I suggest you shadow both! RN’s and NP’s are different so you may want to shadow all 3!
Maybe a PA,NP and or Mary here can post more on this?
Good Luck
Oh boy that’s an interesting question. Having worked on both sides of that “fence” now, you’d think I could articulate an answer but I fear I may lapse into jargon… I will try not to.
I think Bill gave a good response. Nursing is about those actions that will help restore a person to health or maintain a person’s health. In the hospital setting, such actions might include: assessing a person’s response to medication (e.g. pain med), taking blood pressure (how did he respond to the new BP med?), talking to find out what aspect of a person’s hospitalization is most challenging for him, explaining a person’s treatment to a family member, checking a comatose patient’s response (via monitor readings) to ventilator settings, etc. etc. etc. The knowledge base required for performing in this setting includes knowing the normal parameters of body functioning and human response - for example, knowing normal heart rate and blood pressure; knowing the abnormal functioning that accompanies illness (e.g. normal heart rate of around 70, heart rate with a fever could be 90 or 100). You need to have a basic understanding of the physiology underlying the patient’s body’s response to illness, surgery, medications, treatments.
The physician needs to look at a person and diagnose the problem, prescribe the treatments that will hopefully treat the problem, and assess the person’s response to those treatments. There is definitely some overlap.
In the hospital, nurses are the ones who are in charge of the minute-to-minute care of patients. They carry out care that is prescribed by the physician as well as care that does not need to be addressed by the physician but is also integral to the patient’s well-being and recovery. For example, while the physician may prescribe a cardiac diet, the nurse will be the one to determine that the patient doesn’t understand the menu choices, and explain to him how he needs to choose his menu selections. Or, the physician may prescribe Lovenox (low-molecular-weight heparin for anticoagulation) but the nurse teaches the patient how to inject this himself so he can go home. Or the nurse reports back to the physician that the patient isn’t going to be able to perform this skill and will need some other sort of treatment.
You’ll read a lot of people on other boards (cough - SDN! - cough) trash the nurses because their job is “to follow my orders.” That’s a decidedly inaccurate view of nursing. Nurses are educated in anatomy and physiology and much more. They aren’t robots who just blindly do what someone else says. Doctors can prescribe wrong meds, wrong treatment and nurses have a responsibility to make sure the patients they care for get the RIGHT drugs and RIGHT treatments.
You may recall the story some years ago about the patients who died at Dana Farber Cancer Institute in Boston when they were given an inappropriately mixed experimental chemo agent. Among the health professionals found liable in that investigation were the nurses who did not ask the right questions about the chemo they gave.
Oh, finally I gotta say that it’s the nursing programs that really care about this. While I heard about “the medical model” all the time in nursing school, and had it drummed into my head all the ways in which nurses did NOT practice “the medical model,” I don’t believe I EVER heard the term while in medical school nor have I heard it in residency. You can’t get away from hierarchies and regretfully I have observed that the field of nursing has a big collective chip on its shoulder about the status of nursing, which I theorize leads them to need to come up with phrases like “medical model” and “nursing model.”
Hmmmm I already said “and finally” once but one last comment: I LOVED being a nurse. I loved caring for patients, loved what I did. Nurses are great in my book, and have a really tough job. I am not so keen on nursing education, which I think has spent way too much time justifying its existence. OK 'nuff said.
Dunno if this helps!
Mary
Hi, goo!
Mary and Bill had some excellent comments. I will add just a little bit of my perspective on why I chose to pursue medical school in the middle of my nurse practitioner program.
It had nothing to do with the nursing vs the medical “model”. When I became a nurse (late in life), I realized that the healthcare field was where I belonged. It was the patient interaction that really had me “hooked”! Unfortunately, when I looked at advancing up the ladder in nursing, I realized that it would take me away from the bedside and close patient interaction. That was one reason I began to consider becoming a practitioner. To make a long story short, I started my nurse practitioner program 3 1/2 years ago and I will finish this December as soon as I defend and submit my thesis. 
As I got into the NP program, two major factors impacted my decision to go to medical school. The main reason was that I felt I didn’t comprehend the depth of the “science” behind the illnesses I was treating. I liken it to cooking: I am a great cook as long as I have a recipe to follow! But, put me in a kitchen stocked with all the ingredients you can imagine and ask me to come up with a dish on my own–I wouldn’t know how to begin! I don’t understand how the ingredients (baking powder, baking soda, salt, sugar, flour, eggs, etc.) work together to enhance the final product. The same is true with being a nurse practitioner. Without the background in chemistry, biochemistry, histology, immunology, etc., I am really at a loss as to how the human body operates on a cellular level. Therefore, I cannot “think outside the box”. I can only follow what I read or have been told that I should do to treat an illness. When a patient asks me a question that involves UNDERSTANDING what is going on with a disease process, I have no foundation on which to form an intelligent response. I believe that for me to give the best care possible, I need to grasp all the inticracies of medicine and base my response on a solid base of scientific knowledge. (I’m not sure I explained that very clearly, but it is a major reason why I, personally, could not be satisfied treating patients as an NP.)
The other incident that was truly an “eye-opener” happened when we were doing a case study on a patient that we discovered during the process of investigating the case was suffering from AIDS. Part of the assignment was to find out all about the pathophysiology of the disease process and how AIDS is treated. However, one of the questions asked, “To whom would you refer this patient?” All of a sudden, I was struck with the idea–Why should I have to refer them? Wasn’t I intelligent enough to treat this patient? Of course, I was. Now, ignore all the implications of a family physician treating AIDS. Maybe a FP would refer this patient–I don’t know. What really upset me was the limitations that I would be practicing under as an NP! 
Even in Wyoming, where I can now practice independently without ANY required supervision by a physician (which is as good as it gets for a NP), I am still limited to managing “minor acute illnesses and stable chronic conditions”. Was that really what I wanted to do when I had the opportunity to go to medical school? ABSOLUTELY NOT!!!
Now, granted, if my circumstances would not have allowed me to pick up and move from my home state to attend medical school, I would have been truly thankful that I could be a nurse practitioner. After all, I am the type of person who makes the best of whatever situation I find myself in. I would have made it my goal to be the best and most informed NP possible. But, when I had the opportunity to pursue my dream of becoming a doctor, I was not about to say “no” the second time around. Nurse practitioners play a very valuable role in our country’s healthcare. I just wasn’t going to be satisfied with the limited role in which they are required to practice.
Hope that helps add another perspective to this interesting question.
Lu
First let me say Mary did an excellent job. Well said it was impressive.
I am in a little different situation than the others on this list. I am currently a Flight Nurse and stil work ER, ICU etc. I dont delineate “nursing model, Medical model” i just see different roles with different knowledge sets.
In the ER i was definitly working in what people would call the Medical model and much more so as a flight nurse. Currently I can do advanced procedures such as rapid sequence intubation, chest tubes, central lines,pericardialcentisis, crics as well as carry about 40 drugs i give at my disgression without direct physician control, its as independant in critical care as any RN can ever get.
So whats my point? Flight gave me a taste of medicine. I am an A type personality so i ended up at the top of my profession doing research, publishing and as independant as i could be, there is nowhere to go. I had always discounted becomming a physician as i had a couple of hang ups:
1) didnt really think i was smart enough to get through the O chem and the MCAT (still wonder about that)
2) thought i was too old (until i stumbled across this cool website and people like Mary R.)
Anywho, that taste of what it must be like to be a physician made me hungry and so I am working toward physician level. Being an RN is a great profession, the flexability and the portability is unmatched. For some, it is 100% satisfying and they feel totally fulfilled.
What i see as the main difference i liken to any sports team. Physicians are the coaches and the rest of the professions are parts of the team in the game. The coach, like the Doc, knows every position and 10 steps beyond each position. As the leader calling the plays the coach takes ultimate responsibility for the win… or the loss. Medicine is very similar. As an A type personality I liked being apart of the team until i hit the ceiling, no matter how much i learn on my own i will never be the coach as an RN. To reach that potential I need the extra training, knowledge and understanding which only comes with the physician level.
So, was it the money? Nope, i make good money (wife is an RN as well and we have no kids). Is it the need to be in control? Nope, i have that in my current job. It has everything to do with knowing what i dont know and attaining that higher level of practice to make more of a difference and reach my own potential.
When i looked at the NP and PA roles all i saw was glorified helpers. They often get the scut work and the non-critical patients. Mid levels never reach the potential or knowledge level of a physician. In the role i currently have i do much more independant acute critical care medicine than any PA’s or NP’s I know. For me, this did not seem to satisfy my need to “know what i dont know” or reach the potential i felt I had. I would always be wondering what it would be like to be a physician and in my head hearing the ever regrettable “I wish I had…” statement.
Hope that makes sense.
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