Those who are looking at a career in healthcare and want to spend as much time as possible focused directly on patients will have two main paths to consider: becoming a physician or becoming a nurse practitioner. Some people have strong views about which is best, but the truth is that if people were not drawn to both, the whole system would fall part. They are complementary ways of doing things and to excel at either one requires understanding and respecting the other.
This article is designed to make the decision easier by examining the key differences between these two career paths. Remember that the choice does not hinge on deciding which is best overall, but on working out what will be the best fit for the individual. As such, students will need to take into account their own natural abilities and reflect on their long-term life goals. Whichever they choose, they will have the satisfaction of knowing that they are dedicating their lives to improving the lives of others.
As historical phenomena, physicians and nurses come from very different traditions and follow very different philosophies. Evidence of people taking care of those who were ill or injured goes back far into prehistory, with even our Neanderthal cousins practicing it. Professional doctors have been around for about 5,000 years — our earliest records come from Ancient Egypt, where a physician called Imhotep produced a medical manual describing more than 200 different diseases and clearly drawing on an established history of treatment. By contrast, nursing first emerged as a distinct practice around 2,000 years ago, with administrative documents from Ancient Rome establishing its importance in the city’s hospitals.
With these different roots, physicians developed a tradition focused on categorizing ailments and prescribing specific treatments for them, whereas nurses took a holistic approach, not so much treating disease as promoting wellness. To a large extent, that still holds true today. Physicians take an analytical approach to diagnosis and treatment whereas nurses look at how different symptoms affect the patient on a day-to-day basis, factoring in personality and lifestyle and looking for solutions that will work for the individual.
Symptoms and diagnosis
Traditionally, while both physicians and nurse practitioners have identified symptoms, the latter have reported them to the former, who have been responsible for diagnosis. This has changed a lot in recent years, however. Physicians remain responsible for diagnosing serious ailments, but nurses are taking on more and more responsibility for diagnosing minor ones and, in those cases, directly establishing treatment protocols. As nurses tend to spend more time with patients, they often notice things that physicians overlook, yet it is to physicians that most patients first turn when they are worried about new symptoms themselves.
Physicians usually find out about symptoms when patients visit to discuss them, or when they make specific inquiries about chronic conditions. This immediately puts the focus on diagnosis. Nurses are more likely to identify symptoms directly through the process of providing care, or to learn about them in general conversation with patients about their health — a process that experienced nurses get very good at. Although they record these in patient notes, they do not place as much focus on identifying the cause, recognizing that sometimes it is actually more practical to focus on treating the symptoms. Sometimes patients can experience significant suffering as a result of symptoms, the origins of which may be hard for anyone to pin down, and in these cases specialist nurses often take the lead in looking for means of providing relief.
Testing and results
After identifying symptoms, it is often necessary to conduct tests in order to get a clearer picture of what is going on. Physicians are responsible for invasive tests such as biopsies, which may require sedation or even general anesthesia, but nurses take on responsibility for most day-to-day testing. This includes taking blood from patients and collecting urine or stool samples. Where there is no overall diagnosis, these are usually sent directly to the presiding physician following laboratory processing, so that the physician takes responsibility for analyzing the results and determining what they are most likely to mean.
Where an overall diagnosis already exists, test results are increasingly a matter for nurses to keep track of, with the results recorded in patient notes but requiring attention from physicians only where there is significant change (or a significant failure to change after the application of treatment). Nurses take full responsibility for most ongoing monitoring, whether it is for long-stay hospital patients or for those with chronic conditions living in the community. This type of monitoring also includes things like blood pressure and blood sugar checks, as well as keeping track of patients’ weight and engaging in ongoing conversations with them around matters like diet and exercise.
Physicians and nurses also have different roles to play when it comes to undertaking the procedural tasks involved in patient care. Again, physicians are responsible for invasive procedures — everything from catheterization to installing Hickman lines. They also tend to handle tasks like spinal taps where patients are frequently resistant, and a sense of greater medical authority is important to communicating the vital nature of the procedure. They usually handle higher risk procedures where there is a danger of lasting tissue damage, which extends to tasks like the first fitting of feeding tubes. Nurses can then take over and deal with replacing such tubes, once any specific concerns related to individual patients have been established and clear parameters set.
Nurses take care of less invasive procedures like setting up drips, and take responsibility for ongoing tasks such as wound care. They also supervise those tasks that patients are expected to take care of themselves, making sure that they continue to take medication as prescribed and stick to important exercise routines. They directly undertake those tasks in situations where patients are not competent to handle them — most commonly with young children, elderly people suffering from dementia and severely affected stroke patients. Physicians tend to begin their training by learning about diagnosis and acquire these practical skills later, whereas for nurses, these are usually the very first things on the agenda, because the starting point is optimizing general patient health.
When it comes to the provision of care, it is generally assumed that decisions are made by physicians and the work is done by nurse practitioners, but this is a little unfair to both. It tends to be physicians who take on the task of delivering diagnoses to patients, which is in itself a form of care, and requires significant skill when there is the potential for that news to be upsetting. Increasingly, physicians discuss care protocols with patients themselves, especially where significant choices are available. Nurses, meanwhile, are taking an increasingly active role in designing care protocols once their outline has been established, or where the risks are lower.
Most day-to-day care is still carried out by nurses. This includes not just those tasks directly related to health but also things like changing beds, assisting patients with bathing and toileting, and talking through their worries with them. In the community it can involve telephoning or visiting elderly or chronically ill patients to make sure their needs are met, supporting addicts who need urgent counseling if they fear they are at risk of relapse, and working with new parents to ensure that their offspring are well cared for and developing as they should be. It is physicians who patients tend to turn to for information and nurses who they seek out for emotional support.
One notable difference between the way that physicians and nurse practitioners approach their work is the way they engage in collaboration. At the most basic level, physicians spend a lot more time working alone, often taking sole charge of the medical work done with individual patients. Nurses, however, mostly work in teams, and in hospital settings, individual patients will usually be attended by multiple nurses. Nursing involves a much stronger sense of community and interdependence, whereas physicians often socialize together but tend to discuss cases more as a matter of academic interest.
This becomes more complicated, of course, when a patient has multiple co-morbidities or otherwise complex needs. In this situation, doctors are generally responsible for making referrals (though suitably qualified nurses have recently become able to refer patients to physiotherapists and dietitians). Where physicians are engaged in this type of collaboration, it is managed hierarchically, with the primary physician taking overall responsibility and specialists conducting assessments and feeding in information. Multiple practitioners may meet to discuss a case, but not usually in the patient’s presence. In nursing, however, specialists often work directly alongside the nurses responsible for general patient care, giving the latter the opportunity to develop key skills that will improve their ability to look after those specific patients going forward.
Physicians have a role in patient advocacy when contributing specialist knowledge in the type of framework described above, where they may feel that the course of treatment needs to be changed in order to protect the patient’s best interests. They may help individual patients to lobby for access to new or experimental treatments, and they may sometimes speak in court in order to ensure that children or other patients deemed incapable of speaking for themselves can access treatments that their parents or next of kin object to. These scenarios are relatively rare, however, and day-to-day it is usually nurses who advocate on patients’ behalf.
Advocacy of this sort does not apply only where patients are unable to give legal consent. It can also be necessary for a nurse to step in if a patient is anxious, fatigued or simply lacking the level of articulacy necessary to assert their wishes. Sometimes a nurse practitioner needs to step in and tell a physician when a particular approach to treatment is too much for a patient to cope with and needs to be modified.
More commonly, nurses take on the role of patient advocate in dealing with family members. This can range from stepping in to help when a patient is getting exhausted by frequent, lengthy visits, but does not want to upset family members by asking them to be there less often, to negotiating on the patient’s behalf when family opinions differ about the best approach to care. Nurses also need to speak up for patients dependent on day-to-day kinship care who are experiencing neglect, suffering because procedures are being carried out incorrectly, or simply feeling suffocated by too much fuss.
Education and training
Aside from the jobs themselves, attaining the qualifications needed to work as a physician or a nurse practitioner is a very different experience. Physicians spend a lot longer in full-time education in the first instance — usually five to seven years — before they can start applying for jobs or practicing independently. Although they usually serve in junior roles during part of this process, this does not bring in much money, so most are carrying significant amounts of debt by the time they graduate. These days, online learning has made it easier to undertake some of this training part time, which is making it possible for more people from disadvantage backgrounds to become physicians, but the sheer number of hours required to study this properly alongside full-time work is off-putting for a lot of people.
For nurses, the picture is very different. Initial training can be completed in as little as two years, following which it is possible to start working full time in the profession. Even during training, students will normally receive remuneration for clinical hours contributed under supervision. At each subsequent stage, frameworks are in place to enable them to earn while they learn, so when they are looking at specialties and weighing up the benefits of FNP vs AGACNP study, funding options will not be among the things they have to consider. Rockhurst University courses allows for study online with flexible hours, and shift managers will help students work out how to fit this around their work without exhausting themselves. While most physicians go on to specialize and enhance their academic knowledge, with nursing, ongoing education is built into the very bones of the profession.
Working hours and remuneration
One of the other big differences between working as a physician and working as a nurse practitioner is the structure of the working day. Nursing jobs generally take two forms. Those working as a part of a general practice team in the community or at an outpatient clinic will have a fixed working day, usually nine to five, after which they can go home. Those working in a large clinic or a hospital will be on a shift system, but they will still have a set number of hours and once their shift ends, that is it. A doctor, however, will be on call 24/7 in case of emergencies. This does not strictly apply during vacation time, but even then they may be contacted urgently to give advice about a particular patient, and they will have a duty to step in if somebody in their immediate vicinity has a health emergency.
In return for taking on this additional pressure, and in recognition of the higher cost of training, the average physician earns a significantly higher wage than the average nurse. Nurses who work their way to the very top of their profession can command similar salaries, however. Immediately after qualifying, nurses are already able to earn better wages than people at a similar level in most other professions.
Many people left the healthcare sector as a result of the COVID-19 pandemic, which means that there are currently a lot of opportunities available for both physicians and nurse practitioners, but especially the latter. Because of an aging population and people living longer with chronic illnesses, it is unlikely that there will be any point in the next few decades when it will be difficult to get a nursing job.
Physicians do have one major advantage, in that they are nationally licensed by a single body, meaning that they can work anywhere in the country without needing additional paperwork. Nursing is licensed differently in different states, so if one decides to relocate, they will need to do their homework first to find out whether they will need to apply for a new license (which usually requires sitting an additional exam). The good news is that this difficulty may soon disappear as more and more states are agreeing to harmonize their licensing requirements.
Both the medical and nursing career paths have a lot to offer to hard working people who love having the chance to learn and grow. Rates of job satisfaction are very high, and it should go without saying that healthcare benefits are good — people like to look after their own. Whichever is the preferred choice, both routes lead to a long and fulfilling working life that will really make a difference.
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