Is becoming a Nurse Practitioner an easier route into medicine?

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Doctor or nurse practitioner

 

What a question! It seems deliberately designed to cause a slight clenching of the jaw in many a professional medic (also known as a doctor).

However it is a genuine question that is asked fairly frequently in the real world by people thinking about medicine as a career path.

The very fact that the question is even asked, must surely tell us something about the confusion that exists about the changing roles of professionals that work in healthcare and the very bad job we have done as doctors (and nurses) in clarifying key differences.

So in the following few paragraphs I will attempt to set the record straight and dispense some career advice at the same time.

Nursing, at it’s core involves caring for the sick and infirm. Traditional training for nurses reflects that, and a good nurse can make the difference between life and death for multiple patients simultaneously whilst making each of these patients actually feel cared for and comfortable. A good nurse can make the difference between a successful and a failed surgical procedure.

At the heart of nursing lies close adherence to protocols and to an overall plan of treatment set out by a doctor.


Medicine on the other hand requires an understanding of the sciences that underpin clinical medicine and an ability to apply that understanding to real life clinical problems. This may involve dealing with uncertainty, high levels of technical ability or even taking responsibility for deciding what to treat and what not to treat in each unique context. Medicine often involves close adherence to protocols but doctors are required to have an understanding that goes far beyond the protocol, and should always question whether protocols or guidelines are appropriate for the situation at hand.

This is all part of medical training.

Why do you want to be a doctor

 

So, where do nurse practitioners fit into all of this?

Well, a nurse practitioner is a nurse that has had extra training to perform some of the tasks that a (often junior) doctor might otherwise perform.

These might, for example involve seeing patients in general practice with ‘simple’ ailments that should free up a doctor to see more complicated cases. In some GP surgeries and hospitals, nurse practitioners may run asthma or diabetes clinics for example where monitoring of disease and adjustment of medication can be carried out without a doctor. They may have some limited  prescribing rights and may be able to perform certain aspects of surgical procedures, vein harvesting in cardiac surgery, for example.

Because nurse practitioners have never been to medical school, they should not be expected to have the knowledge that a doctor should have about the conditions they manage. They are therefore supervised to varying degrees by doctors to troubleshoot any problems that may arise. A doctor will often take ultimate responsibility if something goes wrong.

Because much of the day to day of clinical practice is simple pattern recognition and adherence to protocol, nurse practitioners are able to deal with many of the problems that traditionally required a doctor. Many doctors worry that, without full medical training, nurse practitioners may make mistakes or miss important pathology which is often hidden among the routine cases in a busy clinic.

 

Should you consider a career in nursing?

If you are truly undecided about which sort of healthcare career you want to pursue, nursing my well be worth looking into.

However, we don’t feel that a nursing career will satisfy the typical medical applicant.
In spite of the considerable political power held by supporters of nurse practitioners and their ever increasing role, it remains the case that when someone wealthy, well educated or powerful falls sick, they turn to a fully qualified doctor for obvious reasons.

Agree?
We’d love to hear your thoughts on twitter!
Use the hashtag #medicineornursing

 

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4 Comments + Add Comment

  • Antonie - Laurentiu Martiniuc January 21, 2015 at 9:44 pm

    What would you recommend in the case of a psychology student ? ( who narrowly failed to get into a British medical school, but had to choose a different route in the UK due to poor prospects in the home country). In addition, getting into a similar career(clinical psychology) is as competitive as Graduate Entry Medicine.

    • doceatdoc January 26, 2015 at 3:45 pm

      Hi Antonie,

      I would say that psychology may be a better route to take, especially if you want to go for graduate entry.
      It has a similar scientific rigour and a career as a clinical psychologist can have many similarities with similar medical sub-specialties.
      I would certainly consider psychology followed by clinical practice (or even graduate entry medicine) over nursing, if you are medically minded and narrowly missed the boat.

  • Confused June 7, 2015 at 12:16 pm

    I have worked for the NHS in a Band 4 clinical role (non nursing) for the last 18 months. In that time I have come into contact with healthcare professionals of all types. My interactions have confused me…a lot!

    I have had NP’s/ANP’s/Specialist Nurses telling me that they know as much as Dr’s, can do anything a Dr can and they can prescribe any drug. If this was the view of a single NP/ANP/SN then I would balance that view against the views of the others. However, every NP/ANP/SN held the same view.

    I have also had Specialist Paramedics/Advanced Paramedics tell me that at the scene of incidents they can do everything a Dr can.

    Then there is the introduction of PA’s and the recent discussion that, in order to address the GP crisis, PA’s will be introduced to General Practice. Whilst I haven’t come into contact with any PA’s, I have read their views on forums. They believe that because they come from nursing, paramedic, physiotherapy backgrounds and because they have completed further training, they are able to do everything a Dr can do including prescribing.

    All of the above believe that they hold the autonomy for their decisions, that they don’t ‘answer’ to Dr’s, and that in reality their roles/decisions are not overseen by Dr’s.

    I have applied to Medicine but have started to wonder whether Dr’s have a future with the increased introduction of these roles. Will I find in 10, 20 or 30 years that I have been replaced by these roles as a cheaper way of delivering healthcare (although the NP’s, ANP’s, SP’s and AP’s I have spoken to joke that they are on more money than Doctors (excluding Consultants)).

    Overall, I am confused as to the difference between the roles, especially based on the views of those I have spoken to. From my conversations, in order to prepare myself for a medicine interview, it appears there isn’t any! Dr’s have told me that the lines have been blurred and they can’t really tell me what the difference is!

    I thought that the difference was between the nursing model and medical model, however, the nurses tell me that they are trained in both.

    Is there really a difference? Have or will Doctors become obsolete?

    Oh, i’m confused…!

  • Alex Kanaan July 9, 2017 at 1:29 pm

    This is an old thread but I think I can help clarify this a bit as well. There are only 4 professions at this time that can autonomously practice medicine at varying degrees: MD, DO, Advanced Practice Nurses (i.e., NP, CRNA, CNM, CNS), & PA.

    MD & DO have gone to medical school and have completed residency’s in their respected specialties. They typically have undergraduate degrees in science majors (e.g., biology). Medical school, regardless of your desire to be a family physician or a cardiac surgeon, is the same for all students. Differences lie in a students grades in medical school, and their STEP examination scores that allow for them to differentiate and be more competitive in choosing a residency. Higher performers in medical school will typically go on to specialize if they choose, and lower performers will be left with fewer options for residency and a desired specialty. For that reason, medical school is so rigorous. Students can potentially become highly specialized, or remain broadly focused such as family medicine.

    For nursing (in particular, nurse practitioners), they aren’t trained to specialize in a single area of medicine (e.g., cardiac, neuro, etc); but are population focused. That is, NP school does not train for potential surgeons or neurologist. All students will finish with the same expected scope of practice and abilities in their chosen population focus. Do not get it confused: though NP school may not train students at the level of medical school training (because of what I said before), NPs are well trained (depending on the school you go to) for practicing medicine in primary care areas for their chosen population focus (i.e., pediatrics, older adult, adult, women’s health). NPs do not have a formal residency program. However, they do have clinical rotations (varies between 500-1000 hours) and typically have years of previous clinical experiences as registered nurses. The average NP has 10-11 years of experience as a registered nurse and a bachelors of science in nursing (BSN).

    Hope this helps.
    – Alex, FNP