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| Before, doctors become nurses. This time, it's the other way around. |
Medicine, as what everyone knows, deals with the treatment of disease. Nursing, on the other hand, deals with the biopsychosocial aspect of the disease, or dealing on how to care for the patient.
In short, Medicine deals with curing, while Nursing deals with caring.
In a career options interview that was recently conducted at a certain nursing school, student nurses were asked what career option they would like to pursue after nursing. During those interviews, majority of student nurses answered Medicine as a suitable career path, apart from several other choices such as nurse educator, specialty nurse, and a lot of others.
Several years back, particularly in the early to mid 2000's, the social trend was that medical doctors shifted to nursing in order to earn a better living and a better source of income. What leads doctors to do this?
According to an article by Dr. Jaime Galvez-Tan on "The Phenomenon of Nursing Medics (Doctors becoming nurses)," nursing has "highly competitive salary rates, attractive compensation and benefits, good living as well as working conditions," in which this "all in all translates to a better life and security." (1)
This prompted a lot of degree holders, including doctors, to study nursing in the hopes of a better job opportunity. This led to an inverse effect: a decline in the number of medical doctors and a steep increase in the number of nurses in the Philippines.
But, the increasing number of nurses led to an oversupply in the country. According to a Philippine Daily Inquirer article dated November 10, 2011, the founder of the Asia Pacific Action Alliance on Human Resources for Health (AAAH), Dr. Suwi Wibulpolprasert, described the country as a "diabetic" with its oversupply of human health resource. (2) This prompted the Department of Labor and Employment to advise "newly licensed and unemployed nurses to seek alternative employment rather than wait for job openings in medical facilities." (3)
What happened, in short? There was an increase of job unemployment in nursing. Doctors, other degree holders, and young upstarts kept on jumping ship until the ship overloaded and eventually sank, along with their supposed hopes and dreams for a better life.
Recently, a lot of articles about the shortage of medical doctors popped out of the internet. According to a recent article by the Philippine Star dated January 31, 2014, the President of the Philippine Medical Association (PMA) Leo Olarte said that there were "only 70,000 'active' PMA members to serve 100 million Filipinos." He stated that "the growth in our population should be complemented by the increase in the number of doctors." He also said that “our population is expected to rise so the problem on the shortage of doctors will surely worsen.” (4)
This poses a striking question: is it worth it to enter Medical school after Nursing school?
Medicine, as what everybody knows, is an expensive course to pursue. Tuition fees skyrocket to as much as PHP70,000+ in state-run schools to PHP120+ in private medical schools such as UST, UERM, FEU-NRMF, ASMPH, and others. Financially-capable nurses, with the help of their parents or relatives, are given this opportunity to pursue this road less-traveled. For those who are well-deserving but financially incapable, they can opt for scholarships in order to pursue Medicine. But still, the financial burden is what keeps majority of nurses held up in pursuing another level of health education.
There are some nurses who also feel that they want to step up to a higher level and become a better health care provider. Medicine provides the benefit of allowing nurses who become doctors to diagnose and treat disease without the risk of losing their nursing licenses, mainly because of the perk of being supervised by a licensed physician, and also, eventually acquiring a medical license. Medicine teaches an more in-depth discussion of diseases which were also learned in Nursing. The diseases that were learned in Nursing are discussed in detail in Medicine, including the pathophysiology and management of these diseases, now in medical parlance. Skills-wise, there is an enhancement of the abilities nurses were able to learn back in nursing school, such as the skill of nasogastric tube (NGT) or Foley catheter (FC) insertion. Additional skills are also learned, skills which breach the legality of the Nursing profession, such as invasive procedures like intravenous (IV) line insertion (unless the nurse has an IV therapist license), thoracentesis, appendectomy, central line insertions, and many more. It is said that Nursing is the only undergraduate degree where "medical skills are performed." (5) Also, the respect is great when a nurse becomes a doctor. Gone are the days when patients and relatives scorn at innocent and kind nurses for things that are out of the nurses' hands. Patients and relatives respect doctors at a level that will make you feel proud of who and what you have achieved.
When a nurse becomes a doctor, the skills that were learned from Nursing school are also brought with him/her to Medicine. This applies well to clinical clerks or junior interns (J.I.) who took up nursing as a pre-med course. This is because what doctors do are also what nurses do: take the patient's history, perform physical exam, and do basic procedures like vital signs monitoring. This means that what doctors do is not new to nurses. This is a big advantage compared to other pre-medical courses. The basic knowledge of disease nurses learn also give them the advantage over others who enter medical school. Nurses, through lessons learned during Medical-Surgical Nursing, Maternal and Child Nursing, and others, are able to respond well to diseases that are laid on to them when they become starting doctors. This is concurred by a lot of health care providers, particularly Medical Consultants who explicitly admit that Nursing is THE best pre-medical course today.
If there are advantages, then there are also disadvantages. Nurses regularly work 8-12 hour shifts. Doctors, well, they don't. Registered Nurses who work in hospitals are well-aware that doctors work 34-hour shifts once every 3 days, sometimes every other day, or worse, everyday (it happens in some institutions and residency programs). Doctors also carry a heavy burden of being the so-called "Captain of the Ship" in legal matters, in which the doctor (usually surgeon) is responsible for ALL actions conducted in the course of the operation. (6) (7) Apart from that doctrine, doctors carry a lot of legal responsibilities, prompting them to practice this so-called "Defensive Medicine," or when doctors "order tests, procedures, or visits, or avoid high-risk patients or procedures, primarily (but not necessarily or solely) to reduce their exposure to malpractice liability." (8)
Just remember what one article states:
"Nurses can become full pledged doctors if a higher education is pursued in a medical school. Like other pre-medical courses, BS Nursing can be used as an undergraduate course to qualify an individual to study in a medical school. Unlike other pre-medical BS courses, having a degree in nursing will already make an individual a professional – a nurse, and can already start practicing their profession and earn by working in clinics and hospitals." (9)
There are a lot of advantages and disadvantages of taking that big leap from Nursing to Medicine. If you ask any doctor who was once a nurse if jumping ship from nurse to doctor is worth it, most would answer that it is one of the best decisions they have made. The road to becoming a doctor is definitely rough. But, with a loading dose of heart and a maintenance dose of patience, the road from being a nurse to a doctor will just be short, and once you know it, you'll be on your way to becoming the best doctor that you can be.
Want to join the RN, MD Phenomenon?
Think about it.
Sources:
(1) Galvez-Tan, J.Z. The Phenomenon of the "Nursing Medics"Doctors becoming nurses: The Philippine Experience. http://rcpsc.medical.org/publicpolicy/imwc/8sess4_abstract_tan.pdf
(2) Mongaya, C. Oversupply of nurses but no jobs. Cebu Daily News. November 10, 2011
http://newsinfo.inquirer.net/91509/oversupply-of-nurses-but-no-jobs
(3) Jaymalin, M. DOLE advises nurses to seek alternative jobs. The Philippine Star. February 26, 2013
http://www.philstar.com/headlines/2013/02/26/913217/dole-advises-nurses-seek-alternative-jobs
(4) Crisostomo, S. PMA warns of worsening shortage of doctors. The Philippine Star. January 31, 2014 http://www.philstar.com/headlines/2014/01/31/1285056/pma-warns-worsening-shortage-doctors
(5) -- Nursing as a Pre-Req for Med School Applicants. Premed 101 Forums. April 10, 2011 http://www.premed101.com/forums/showthread.php?t=50889
(6) Blumenreich, G. (1993) Captain of the Ship. Legal Briefs. Journal of the American Association of Nurse Anesthetists Vol. 61 No. 1 pp. 3-6
https://www.aana.com/newsandjournal/Documents/legal_briefs_0293_p003.pdf
(7) McConnell v. Williams, 361 Pa. 355, 65 A.2d 243, 246 (1949)
(8) Manner, P. (2007) Practicing defensive medicine - Not good for patients or physicians. American Academy of Orthopaedic Surgeons.
(9) -- Can A Nurse Become a Doctor. http://howtobecomea-doctor.com/wordpress/can-a-nurse-become-a-doctor/
