Nurse and Techs aren't necessary; physicians can do their jobs without them.

[Ivor the Engineer]

In a discussion I'm having over in the Business and Economics sub-forum a couple of posters have expressed their opinion that physicians do not require nurses and techs to perform their job. E.g.,

http://forums.randi.org/showpost.php?p=4369287&postcount=74

I was wondering what other posters may think about this idea?

:)

[bwinwright]

If I was a doctor, making $500,000 or more, I'm sure I could probably do most everything necessary without absolutely needing the services of a nurse. However, if I'm making that kind of money, I think it would be nice give up $40,000 or more to a nurse so they could handle the more mundane stuff for me. I'd probably be willing to pay even more to some hot looking nurse Goodbody type who could perform even more services for me should I be so lucky. Plus, with enough nurses handling the basic stuff for you, it would free you up to see more people, diagnose them, and press on.

[Tatsu]

In larger health care organizations where the MD's, NP's and PA's are expected to see a certain number of patients throughout the day and still maintain a high level of patient care, support staff such as RN's LVN's and MA's are vital to the work flow. By taking care of basic patient care they allow the provider to spend more time treating the patient during the appointment as well as properly documenting the visit afterward.

Can a provider do everything during the course of a visit? Certainly, but it is a waste of a valuable resource, time. It reduces the number of patients a provider can see during a typical day and actually increases the cost of care to those patients. In an age of managed healthcare, support staff are a cost effective component of good patient care. That is my experience, at least. YMMV.

[cwalner]

As a recent consumer of hospital services, I would have to disagree, at least as far as nurses go. Doctors are scientists specializing in diagnosing and prescribing treatment for dissease. Nurses are patient care specialists who focus on the comfort and welfare of the patient while the treatment of the dissease takes it course.

These different focuses require predominantly different skill sets (with a little bit of overlap) and both are completely neccesary for the successful treatment of a patient.

I beleive that the rise of the medical tech field was the result of attempts to cut corners by relegating a lot of the less patient-interactive duties of nurses to a lower-paid individual who did not have all of the patient-care training and experience. While not completely neccesary, they do provide thier use by lowering overalll medical costs.

[Dancing David]

In a discussion I'm having over in the Business and Economics sub-forum a couple of posters have expressed their opinion that physicians do not require nurses and techs to perform their job. E.g.,

http://forums.randi.org/showpost.php?p=4369287&postcount=74

I was wondering what other posters may think about this idea?

:)

Some people haven't a clue. Medical systems do not employee redundant people.

All the parts help it work. Interviewing patients and providing care are something doctors are already limited in.

[Pink Booties]

I'm a PCT, and the idea that physicians don't need nurses or techs is just dumb. Often the physician overlooks important info, or it hasn't made it into the chart yet; there's often a knowledge gap. And it all waits on labs- nobody knows much of what they're up against until the labs come back.

[MRC_Hans]

Nurses do a different kind of job that doctors. Patients aren't just defective machines. Nurses provide CARE, doctors provide repair.

Of course you may be able to teach doctors to do nurse work, but why should you? That would not be cost-effective.

Technicians? I have worked with medical electronics. Have you ever seen a doctor operate a piece of technical equipement? I have. You don't wanna be on the receciving end of that.

In principle, all people could do all kinds of work, but there's a reason some are watchmakers, some are blacksmiths, and some are musicians.

Hans

[Gagglegnash]

Hi

<<Original post redacted>>

[Rolfe]

Oh, him?

I wonder what he means by "tech"?

Could a doctor do everything that a nurse can do? At a pinch I suspect probably, though they cost a lot more per hour.

However, by "tech" does he mean technician, or technologist as I believe the correct word is in America? If so, not a prayer.

Technicians know about the techniques of analysing lab samples, the principles of that analysis, how to do it and how reliable the results are. Technicians know about the proper functioning of big expensive machines that analyse lab samples, take x-rays, take CT and MRI scans and so on. Technicians know about calculating the right amount of a rapidly-decaying radio-isotope to inject to be able to image the required information wiout frying the patient. And so on.

Now if you take each of these technical areas, there will be a few doctors, the top consultants especially, who have mastered the technical aspects to the same depth the technical staff have. But if you gave the average generalist a blood sample and told him to run a blood count on it, he'd just say, haven't a clue, it's not my job anyway.

Yes, you could train a doctor to do these jobs, just as you can train a junior science graduate to do these jobs. But doctors don't come out of medical school with any feckin idea about the principles of laboratory analysis.

Rolfe.

PC. What MRC_Hans and Magnifico said.

[roger]

My god, I pay enough money at the hospital already. Now all I want is for highly paid doctors to take on much more training, and then pay them about $100/minute (only a slight exaggeration in the US) to draw my blood, run it down to the lab, help me get into the bathroom with my IV bag, etc., etc., etc., all while the person in the next room is dying for lack of a doctor. Ya, that's the ticket.

[SYLVESTER1592]

It really depends on what nursing care or technical analysis is required and how often a doctor has to do this. Some things can be learned easily, even the technical analysis. Many doctors learn specific technical tasks in a research setting or out of pure necessity. But depending on the workload and the complexity of some parts of medical care it makes no sense to have a doctor do all the technical tasks in the same way that a doctor does not have to know all the details of a specialty he/ she does not specialize in.
For a general practitioner it may be true that the presence of nurses or technical staff makes no sense, but as the requirement for nursing care and the need for technical analysis increases and becomes more complex and time-consuming, nurses and technicians become increasingly necessary to keep health care affordable and efficient and reduce the workload for doctors who have another specific task.

Doctors are required to know how to interpret the results and understand a method of analysis, but they don't have to know how to load the sample, clean the machine, know what all the alarms mean or anything of the sort. Ofcourse, if the supervisor is a doctor, which often is the case, then he/she will most likely have specific knowledge on the subject. The reason for the requirement is logical: you have to be able to tell the nurse or the technician what you want from them and understand what they try to tell you to find a solution to the problem. Ofcourse, since a technician or nurse has a specific set of tasks in which they specialize, their expertise in this specific field is often greater then a doctors if it's not a task that doctors perform regularly. In all cases the ability to communicate with other staff to find a solution and manage a diagnostic and therapeutic path is the main reason why doctors expand their knowledge beyond their own field of expertise, not necessarily to actually perform the task.

Nurses see a patient for a longer period of time, focussing on the day to day care of a limited amount of patients and see many things that are easily overlooked in a routine examination. Depending on the nurse, a nurses hunch is often more valuable then a single clinical assesment. In the same manner the clinical experience of a doctor is more then being able to run a checklist of symptoms, but requires the ability to asses the severity of symptoms and associate anything that might be out of the ordinary with a specific cause or a set of causes while choosing the appropriate (technical) way to determine whether their assumptions are correct and determine a correct treatment.

Apart from being very inefficient and costly, requiring doctors to do all the nursing and technical tasks, makes as much sense as deciding that doctors should be experts in all specialties and underestimates the value of technical and nursing staff and the added quality of care they provide.

SYL :)

[Demigorgon]

"Nurse and Techs aren't necessary; physicians can do their jobs without them."

Um no, those who would think otherwise are uninformed. No, I'm not going to take the time to inform them. It's just silly.

credit: My wife is an OR nurse.

[Miss_Kitt]

Ivor, I object to you mis-paraphrasing me and subjecting me to a proxied attack by starting this thread.

What I said--as others on this thread have noted--is that a doctor could do what the nurses and "techs" (by which I mean the medical office assistants, not the technicians who run specific imaging equipment); but that it is more efficient to have the higher level of knowledge do only those functions that require that level of knowledge. My argument was not that the lower-level people were not desirable, only that without a doctor, the clinic would not function.

This was in response to your assertion that the highly-paid people in a firm don't deserve to be paid much more than the lowest-paid. I used a medical clinic as an example of why there are tiers of compensation, which reflect the relative value of a person to the firm.

I did not say, or imply, that nurses and technicians are not a value to a medical practice.

Whether this thread represents a deliberate smear attempt on your part or genuine ignorance, an apology is in order, sir.

I await your response, Miss Kitt

[firecoins]

I am a paramedic.

An MD does not need a nurse to do his job. A nurse has too much of her work to do to be an MD also.

MD, PAs, NP, Nurses, CNAs, Respiratory Therapists, Radiaology Technoloigsts, Cardio Perfusionists, lab tech and paramedics have their own job to do. MDs can not do it all.

[SYLVESTER1592]

Looks like you're attempt is busted Ivor... evading the argument by moving the discussion :p

[Physiotherapist]

Ivor, I object to you mis-paraphrasing me and subjecting me to a proxied attack by starting this thread.

What I said--as others on this thread have noted--is that a doctor could do what the nurses and "techs" (by which I mean the medical office assistants, not the technicians who run specific imaging equipment); but that it is more efficient to have the higher level of knowledge do only those functions that require that level of knowledge. My argument was not that the lower-level people were not desirable, only that without a doctor, the clinic would not function.

This was in response to your assertion that the highly-paid people in a firm don't deserve to be paid much more than the lowest-paid. I used a medical clinic as an example of why there are tiers of compensation, which reflect the relative value of a person to the firm.

I did not say, or imply, that nurses and technicians are not a value to a medical practice.

Whether this thread represents a deliberate smear attempt on your part or genuine ignorance, an apology is in order, sir.

I await your response, Miss Kitt


As I see you are from the States, the set up here in the NHS in the UK is a little different to what you have and here in our hospitals, the NHS could definitely not run without nurses. The wards are run and staffed by the nurses (most understaffed at present still) and there is a Ward Sister or Charge Nurse in charge of the ward and here it is really looked upon as the ward belongs to the nurses.

The doctors come and do rounds, but they are not on the ward all of the time in the way that the nurses are to provide round the clock care for patients.

In the NHS, if there were no nurses, it would collapse, which is why nurses are prohibited from striking. They are needed and I have to say that as well as doctors perform their jobs, they could not do the job of the nurse in the same way that a nurse could. This is why nurses have specific training in the way that they do to provide patient care. Their role is totally different and they are a very much needed and valued part of the team, especially here in the UK. Can't speak for the US. Perhaps your healthcare and hospital set up out there is different, but surely you still need nurses there too?

[macdoc]

We have a "nurse practitioner" category here that is working out very well.

http://www.cma.ca/index.cfm/ci_id/43590/la_id/1.htm

It's an intermediary step that eliminates a lot of "no brainer" work for scarce doctor resources.

[ElMondoHummus]

In a discussion I'm having over in the Business and Economics sub-forum a couple of posters have expressed their opinion that physicians do not require nurses and techs to perform their job. E.g.,

http://forums.randi.org/showpost.php?p=4369287&postcount=74

I was wondering what other posters may think about this idea?

:)



After having read this thread and the one housing the linked post above, I think you're reading way too much into those posts. In a very strict, literal sense, a physician does not need a nurse to do his job i.e. his/her specific duty of diagnosing symptoms and determining courses of action - but the doctor cannot properly execute his job without the nurse(s). It may be logically argumentatively correct to say that a doctor does not need nurses or techs to do his job, but it is a meaningless hypothetical construct. Consier other examples:

A ship's captain does not need the seamen in order to do their job of determining what the ship does, where it goes, and how things are done.
A US football quarterback does not need his linemen or other skill positions to do his job of reading the defense and predicting where the ball should either be thrown or run to.
A chef does not need the sous-chef or prep workers in order to design and prepare the menu
But these are all just complex ways of saying that different people have different duties within an organization. A doctor may not need a nurse in order to make a diagnosis, but said doctor would be a fool to attempt to care for the patient without the nurses, technicians, and all other elements of a healthcare giving team also contributing. The fact that the nurse does not normally execute the act of making diagnoses for the doctor (I'm obviously excluding nurse-practitioners in this example, and highlighting office or hospital situations where doctors are available) does not mean that the doctor can execute the remainder of his job without the nurse's activities. The doctor requires a lot of information from a nurse in many situations (for example, in a clinic where the nurse takes the history and records what the complaint and symptoms are). The nurse is not technically directly involved in the execution of the doctor's core duty, but the core duty cannot be carried out in the absence of the other functions the nurse carries out.

Extending the example: A ship's captain simply cannot get the ship where it needs to go without the engineers taking care of the engines, the navigator determining proper courses, and the various seamen handling the mundane duties of a ship. And, an NFL quarterback's job becomes difficult without his linemen helping determine the sort of defense being thrown at him by simple virtue of who they block and where, and the quarterback's job actually becomes meaningless in the absence of the other skill positions because they're the ones he's supposed to deliver the ball to.

Now, other than creating an interesting mental exercise in parsing the statement "... that physicians do not require nurses and techs to perform their job", I really don't understand the purpose of this thread. It's obvious that there are multiple levels of meaning in that statement, and that a direct, strict, literal meaning of the statement is useless when considering the overall operation of an organization. So, question: What's the point of the OP? I'm afraid that I'm missing something here.

[tomwaits]

The question, IMO, should be: can nurses and technicians do their job without physicians? I think there should be more nurses, with their own facilities. They could treat less serious conditions, like broken arms and such. I don't think that kind of stuff needs a doctor, so having to pay for one doesn't seem very efficient.

[Delvo]

Tomwaits, the kind of job you're thinking of is not Nurse, but Physician's Assistant. They have bachelor's degrees in medicine instead of MDs, which is the same amount as some nurses (although there are different "levels" in nursing and some nurses have an associate's degree instead), but the kind of training they've received is different from the kind of training nurses get. They're taught some amount of scientific analysis for diagnosis and prescriptions for treatment. Nurses are taught a different set of skills for taking care of all of the patient's other needs while a doctor or PA does the diagnosing and treatment-prescribing.

Ivor, running away from a discussion you were failing in just to try to recruit others who weren't involved for help in taking ad-hominem potshots at your opponent from a safe distance is not only disgusting, but also just pathetic and lame.

[SYLVESTER1592]

The question, IMO, should be: can nurses and technicians do their job without physicians? I think there should be more nurses, with their own facilities. They could treat less serious conditions, like broken arms and such. I don't think that kind of stuff needs a doctor, so having to pay for one doesn't seem very efficient.
Oh my...

Even if I do value the nursing and technicians contribution to the medical care... It's a time and workload saver and makes sense in a large organisation where delegating tasks makes sense. For a GP it makes no sense at all to employ a nurse if there isn't enough work for the nurse to do. In a medical office during consults, a nurse is unneccesary in a similar way.

For some reason health care means hospital care to most people in this thread, while this is not the case in many instances. While doctors are always willing to defend the value of their nursing and technical staff because they lighten their workload and add to the care for their patients, I think a nurse and technician are most valuable when they do their own job well,... Nursing staff generally understands this very well and won't take unneccesary risks and consult a doctor when something out of the ordinary occurs.

Our hopitals run similarly to hospitals in the NHS. Even in the NHS the doctor is still responsible for his patients and makes the plan for diagnosis, daily care and therapy. Therefore nurses do not run the ward, the doctors do. The nurses execute the plan, after conferring with the doctors during the rounds. Many procedures run according to protocols, but to start them the nurses require autherisation from the doctors to start them, except in predetermined conditions such as a reanimation or a planned procedure. A doctor can decide to make a different plan for a patient according to his/her clinical opinion. If nursing staff plans to do something else which is not in accordance with the doctors orders or plans, they are on their own...and Good Luck to them.

In my opinion, if we are to transpose the medical care to nursing staff then they should be responsible for their actions, decisions and the outcome and willing to defend it to their peers, the board and in court, just like doctors do. In other words, it stops being the doctors primary concern. If we are willing to do that, NP's with more resposibilities and specialized nurses with more responsibilities are possible. It will be a form of medicine without medical science by scientifically schooled doctors or individualized care, and ruled by protocols, but as long as you belong to the majority for which a specific protocol was designed this shouldn't bother you.

I don't think you can ask of a doctor to take responsibility for someone else's decissions, actions or therapy. They wouldn't do that for other doctors, so why for nurses acting on their own? The problem arises when a a protocol which is intended for a specific type of patient overlooks associated problems or is applied to patients for whom the protocol was not designed and can cause delay of treatment or a failure to diagnose a certain condition. Therefore, the decision to delegate parts of the medical care to nursing or technical staff has to be in accordance with what they are able and willing to do and in communication with the responsible physician in order to provide adequate care.

BTW. A broken arm or leg can be a serious condition: nerve damage, tendon damage, blood loss, vascular problems, osteomyelitis etc. Not to mention the decision on how to treat a fracture depending on the location and type and patient related variables that influence the outcome and possible systemic complications following a fracture or the evaluation of other problems associated with a fracture.

SYL :)

[Physiotherapist]

Sylvester,

Nurses do take responsibility for their own actions. In the UK, all practicing nurses have to be registered with the Nursing and Midwifery Council (NMC), so they answer for their actions in the same way that doctors do when they are registered with the GMC.

I believe that it is the same in the US with nurses having independent practice licences?

Also, what I meant about the ward being the responsibility of the nurses, was yes, the doctors will do rounds and prescribe treatment that is carried out by nurses, but they do not have direct control about nursing duties - the ward sister and other senior nurses have this, just as senior doctors have control over junior doctors. As doctors are not on the wards all the time, it is the ward sisters responsibility to keep the ward staffed by nurses at all times. The ward sister has responsibility for duty rostas etc and for ensuring the all shifts are covered to provide patient care at all times. It is not doctors that do this and if there were no nurses working shifts the ward would not work at all, as doctors are not there all the time.

As I said before, doctors and nurses have different roles totally that are dependent on one another and they cannot function without each other.

In GP/Family Practice there are practice nurses working there and there is definitely enough work to keep both GP's and nurses going. Nurses run asthma and diabetes clinics and District Nurses perform home visits for patients and perform all these tasks that the GP's just do not have time to do. Different roles and functions that depend upon one another and if one is missing, the other would not be able to perform as well.

[Physiotherapist]

Tomwaits, the kind of job you're thinking of is not Nurse, but Physician's Assistant. They have bachelor's degrees in medicine instead of MDs, which is the same amount as some nurses (although there are different "levels" in nursing and some nurses have an associate's degree instead), but the kind of training they've received is different from the kind of training nurses get. They're taught some amount of scientific analysis for diagnosis and prescriptions for treatment. Nurses are taught a different set of skills for taking care of all of the patient's other needs while a doctor or PA does the diagnosing and treatment-prescribing.

Ivor, running away from a discussion you were failing in just to try to recruit others who weren't involved for help in taking ad-hominem potshots at your opponent from a safe distance is not only disgusting, but also just pathetic and lame.


As far as I understood, PA's do not have their own separate practice licence - they work under the orders of an MD, whereas and RN has their own independent practice licence.

[T.A.M.]

Depends on what you mean by "perform their job". I know that is not an answer, but it is vital, and here is why.

As a GP, I can perform the day to day clinical assessment/treatment without the help of anyone, however, I need others to help me for...

1. Difficult or complex conditions (specialists)
2. Emergency Conditions (can't treat an MI in my office - not very well anyway)
3. Associated Therapies (Physio, Massage, Chiro, Resp, etc...)

As others have said, most physicians can, in a pinch, perform most if not all nursing duties, but they tend to do them much less efficiently, and without as much skill.

So the question involves so many different scenarios and variable, that it is impossible to answer, except to say:

Find me a physician who says he can perform ALL medical tasks without the help of others, and I'll show you a physician who is FOS.

TAM:)

[Physiotherapist]

Depends on what you mean by "perform their job". I know that is not an answer, but it is vital, and here is why.

As a GP, I can perform the day to day clinical assessment/treatment without the help of anyone, however, I need others to help me for...

1. Difficult or complex conditions (specialists)
2. Emergency Conditions (can't treat an MI in my office - not very well anyway)
3. Associated Therapies (Physio, Massage, Chiro, Resp, etc...)

As others have said, most physicians can, in a pinch, perform most if not all nursing duties, but they tend to do them much less efficiently, and without as much skill.

So the question involves so many different scenarios and variable, that it is impossible to answer, except to say:

Find me a physician who says he can perform ALL medical tasks without the help of others, and I'll show you a physician who is FOS.

TAM:)


Doctors and nurses fulfill totally different functions in relation to patient care and they are educated as such too.

Generally speaking, doctors are educated in the art of diagnosis and treatment, whereas nurses are educated in the art of patient care, as they are the ones who spend most time with the patients.

Both are needed as they are utilising different skills.

[SYLVESTER1592]

Sylvester,

Nurses do take responsibility for their own actions. In the UK, all practicing nurses have to be registered with the Nursing and Midwifery Council (NMC), so they answer for their actions in the same way that doctors do when they are registered with the GMC.

That's true, they do the same thing over here. In this case the midwife has had the specific training for it and only handles those pregnancies which are not complicated and works in communication with the gynecologist/ obstetrician to confer if a patients needs to be admitted to provide adequate care. This is not just an added tasks or resposibility, but a registered and protected occupation requiring specific training (lasting 4 years over here). As I was proposing in my post.


Also, what I meant about the ward being the responsibility of the nurses, was yes, the doctors will do rounds and prescribe treatment that is carried out by nurses, but they do not have direct control about nursing duties - the ward sister and other senior nurses have this, just as senior doctors have control over junior doctors.

They do when it is part of the treatment and not daily care or when the normal procedure (for instance mobilisation of a patient) is either required or contra-indicated. The nurses have control over their schedule and division of tasks and manage most tasks on their own since they are part of the normal protocol and therefore approval has already been implied. When this is not clear to nursing staff it can lead to discord and the inevitable mistakes. This is not a communication problem, but one of attitude i.e. "The nurses run the ward..." In general this is not an issue, because many tasks can be planned at another time, and the urgency for the completion of a task is indicated during rounds.

But what the post I was referring to proposed that we should move other tasks to the nursing staff and let them handle these tasks at their own descretion. If you would like to do that in a setting such as for a midwife, then I see no reason why this would not be possible. It would be highly ineffective and unfortunately this is not possible for many tasks in the medical profession, since unlike a midwife who in general deals with healthy young women, or NP's who deal with a patients having a controlled disease, a nurse often has to deal with with people who are ill (uncontrolled disease) and often in need of care on several levels.


As doctors are not on the wards all the time, it is the ward sisters responsibility to keep the ward staffed by nurses at all times. The ward sister has responsibility for duty rostas etc and for ensuring the all shifts are covered to provide patient care at all times. It is not doctors that do this and if there were no nurses working shifts the ward would not work at all, as doctors are not there all the time.


That is completely true, however this applies mostly to a hospital which has many tasks to perform and with the possibility to divide tasks for a more efficient and cost effective way of handeling patients care. It is much less the case for a GP and eventhough many tasks require help from outside, tasks such as presented in Miss Kitt's post are often handled by a doctor's assistent (with specific training), who does not always perform nursing duties but mainly handles the appointments, prescriptions and administrative tasks. Over here they are not classified as nurses.


As I said before, doctors and nurses have different roles totally that are dependent on one another and they cannot function without each other.

In GP/Family Practice there are practice nurses working there and there is definitely enough work to keep both GP's and nurses going. Nurses run asthma and diabetes clinics and District Nurses perform home visits for patients and perform all these tasks that the GP's just do not have time to do. Different roles and functions that depend upon one another and if one is missing, the other would not be able to perform as well.

These functions are part of our health care system, but are not part of the GP's practice. Over here some of these tasks are shared by the care of the GP and a Nurse practitioner, mostly located within the nearest hospital (such as for diabetes and asthma), while others are part of specialized nursing care at home. They work in close relationship with doctors in other parts of our health care system to refer the patients in case of special conditions in which case GP's make a house call.

As I said before, nursing and technical staff reduce the workload, add to the quality of care and make health care more efficient and are therefore valuable in the health care system. I agree that their roles are completely different as I stated before, and think that the necessity of their work depends on the workload, the type of work and the location. Certainly, no doctor would want to do all the tasks the nursing staff does next to all the tasks he/she already has to perform.

But the image of a nurse treating a fracture without a doctors input on the subject is rather unsettling, especially considering the notion by the poster I was referring to, that this is a less serious condition that does not require any specialized consideration. Since the choice of medical treatment falls under the responsibility of the doctor in charge (even when following the advice of another doctor or in the case of a nurse performing her tasks on the ward), I think this should no longer be the case when nursing staff decides would be allowed to decide how to treat patients without prior consultation or when the consultation can be ignored. Nursing staff does take it's own resposibility, yes, for their nursing care. Not for the prescribed treatment. Most nurses wouldn't want this kind of responsibility either.

It's a big difference...


SYL :)

[Dr. Imago]

Dancing David essentially got it right. But, paraphrasing him, I'd just put it more succinctly: everyone's job in the hospital is important, or they wouldn't be there. Hospitals (and doctors offices) don't like to waste money, contrary to popular opinion. The bean-counters watch everything we do, trust me.

As far as the sentiment in the OP, I'd simple say this (and I am, perhaps, more uniquely qualified than some other physicians to comment... my job, as an anesthesiologist, involves a lot more "nursing" skills than my colleagues): I know how to fly the plane, but I don't know how to repair it. Do we expect the pilot to go out and fix the engine when it's broken? I can interpret a chest xray, but I have no idea how to run the machine that takes the picture. Could I learn? Certainly. But, that's not my job; and, that wouldn't be an efficient use of my time.

Should I prescribe a medications for my patients, then go to each room and give it to every one of them, making sure they take it on time and in the proper amount? Most definitely not. Would that be a good use of my time? No.

Likewise, can I always be at the bedside or at the beck-and-call 24/7/365 of every patient I'm treating when I'm working in the intensive care unit ? Absolutely not. Is it important that we have highly-trained and qualified staff who can be there and know what to worry about so that I can be notified of an important clinical change in the patient? Clearly.

I'm not sure how anyone go the notion that I can be there to do the job a nurse can, or that I want to, and that physicians can do everything for the patient that needs to get done without nurses or technicians. That's just a little bit silly, and demonstrates (again) that most laypeople don't really understand how a hospital or busy practice runs, aside from the caricaturization and misinformation they see on shows like "E.R." and "House" and "Gray's Anatomy", all of which are woeful misrepresentations created by Hollywood solely for entertainment value and have little reflection of what actually occurs in my world.

~Dr. Imago

[jhunter1163]

As an employee of a 22-physician medical office, I can assure you that the ancillary staff (nurse practitioners, nurses, medical assistants, etc.) are absolutely essential to the smooth running of any medical practice. The problems crop up when we don't have enough of them.

[SYLVESTER1592]

Dancing David essentially got it right. But, paraphrasing him, I'd just put it more succinctly: everyone's job in the hospital is important, or they wouldn't be there. Hospitals (and doctors offices) don't like to waste money, contrary to popular opinion. The bean-counters watch everything we do, trust me.

As far as the sentiment in the OP, I'd simple say this (and I am, perhaps, more uniquely qualified than some other physicians to comment... my job, as an anesthesiologist, involves a lot more "nursing" skills than my colleagues): I know how to fly the plane, but I don't know how to repair it. Do we expect the pilot to go out and fix the engine when it's broken? I can interpret a chest xray, but I have no idea how to run the machine that takes the picture. Could I learn? Certainly. But, that's not my job; and, that wouldn't be an efficient use of my time.

Should I prescribe a medications for my patients, then go to each room and give it to every one of them, making sure they take it on time and in the proper amount? Most definitely not. Would that be a good use of my time? No.

Likewise, can I always be at the bedside or at the beck-and-call 24/7/365 of every patient I'm treating when I'm working in the intensive care unit ? Absolutely not. Is it important that we have highly-trained and qualified staff who can be there and know what to worry about so that I can be notified of an important clinical change in the patient? Clearly.

I'm not sure how anyone go the notion that I can be there to do the job a nurse can, or that I want to, and that physicians can do everything for the patient that needs to get done without nurses or technicians. That's just a little bit silly, and demonstrates (again) that most laypeople don't really understand how a hospital or busy practice runs, aside from the caricaturization and misinformation they see on shows like "E.R." and "House" and "Gray's Anatomy", all of which are woeful misrepresentations created by Hollywood solely for entertainment value and have little reflection of what actually occurs in my world.

~Dr. Imago

:)

Then I have a good one for you... actually happened (some parts are changed for anonimity):

Your patient is a man with end stage liver cirrhosis on the high urgency list for a transplant. He has a Hb of 4.7 in an arterial bloodgas taken by the ICU nurse. You have instructed her not to give blood without conferring first and to call if Hb drops any further.
The ICU nurse decides otherwise guided by protocol that says the patient in question should have an Hb of 5 and gives 2 bags of filtered erythrocytes. She doesn't tell you, her shift ends long before yours does and she goes home. A liver is found and the transplantation team has been called in by your collegue, who also does the pre-op assesment. He calls you to confer and you find out that the patient has recieved 2 packed cells, has a high INR and prolonged APTT, for wich some fresh frozen plasma was given, no signs of acute bleeding, further bloodwork is on the way and the department of hepatology has been consultated for the immunosuppression therapy. Blood has already been ordered and the level-one is prepared. Transplantation is planned 1,5 hours from now. The professor of hepatology who is part of the team now calls you after he found out the patient had 2 packed cells and starts telling you how it will be your fault if the liver is rejected.
What do you do?
a. tell the professor of hepatology to "take a chill pill"
b. tell on the nurse who gave the packed cells
c. sit there and let the professor unload his frustration on you and sulk afterwards while taking the blame.

I have a few more of these... and I'm sure you do too if you think hard. But then again, maybe these things never happened in your world either.
That doesn't mean I don't value nurses or techs... But yes, experience taught me to check up on the important stuff.

SYL :)

In case you're wondering... the answer was C. But I still don't know if it was the right one

[cj.23]

Anyone who thinks that a GP can function without the complete support network is probably a GP (MD). I think in a pinch I could run a post-apocalypse practice with a Pharmacist, a Pharmacy Technician and a Vet, and a good British Psychiatric Nurse - oh and an Anesthetist, a few consultants, a surgeon, a decent counsellor, a few dozen cleaners., cooks, secretaries -- look -- it's a nonsense. The general MD ironically could probably be dispensed with before most of the specialists, but no sane person would contemplate such a move!

cj x

[cj.23]

In case you're wondering... the answer was C. But I still don't know if it was the right one


I really think the answer is B, but accept that you acted completely correctly and courageously. Thing is that mistakes do happen, and yet I'm trying to think through where the actual responsibility lies - I guess here with the surgeon. It's one of the issues facing us all - in multi-agency working especially - where does the buck stop? Regardless, the nurse needs to understand there was a problem I guess. :(

cj x

[balrog666]

I would draw a distinct difference in the work performed by doctors, nurses, technicians, et al. in a hospital (i.e., treatment) as opposed to a diagnostic clinic or small medical office.

[T.A.M.]

Doctors and nurses fulfill totally different functions in relation to patient care and they are educated as such too.

Generally speaking, doctors are educated in the art of diagnosis and treatment, whereas nurses are educated in the art of patient care, as they are the ones who spend most time with the patients.

Both are needed as they are utilising different skills.

Thanks for the info. I 100% agree.

I have been in practice as a GP for 8 years. I think the question was sort of aimed at "If you had no nurses or techs around, could a doctor do his job". If that is the case, then I am of the opinion that a GP could perform all he needs to for his particular position, just as a Nurse could perform his/her duties without a GP (although giving out meds without the orders of an MD, with some minor exceptions, might get them into trouble).

TAM;)

TAM;)

[T.A.M.]

I'm not sure how anyone go the notion that I can be there to do the job a nurse can, or that I want to, and that physicians can do everything for the patient that needs to get done without nurses or technicians. That's just a little bit silly, and demonstrates (again) that most laypeople don't really understand how a hospital or busy practice runs, aside from the caricaturization and misinformation they see on shows like "E.R." and "House" and "Gray's Anatomy", all of which are woeful misrepresentations created by Hollywood solely for entertainment value and have little reflection of what actually occurs in my world.

~Dr. Imago

Exactly

TAM:)

[T.A.M.]

Anyone who thinks that a GP can function without the complete support network is probably a GP (MD). I think in a pinch I could run a post-apocalypse practice with a Pharmacist, a Pharmacy Technician and a Vet, and a good British Psychiatric Nurse - oh and an Anesthetist, a few consultants, a surgeon, a decent counsellor, a few dozen cleaners., cooks, secretaries -- look -- it's a nonsense. The general MD ironically could probably be dispensed with before most of the specialists, but no sane person would contemplate such a move!

cj x

lol...exactly. That is why I said that it depends on what you mean by "do your job". I can assess and treat most things, to the point of giving them a referral to PT/MT or specialist, or giving them a script - that is essentially my function as a GP. However, you notice that that then leaves the patient far from completely treated. Likewise, There are times when my diagnosis is not certain, or a skill set beyond my own is needed. That is when I call upon my specialized colleagues to help out.

So I think that if the question is "can a GP treat all patients for any condition, from start to finish, the answer is an obvious - NO!!"

TAM:)

[Ivor the Engineer]

Thanks to SYL, TAM, Dr. Imago, Physiotherapist and others for your informative responses.

Now to my critics.

Miss_Kitt,

I'm sure you would like an apology, but I'm afraid you are not going to get one from me. I have not mis-represented your statement from the other thread in any way at all. I'll quote what you wrote and let others decide if I've taken it out of context (bolding mine):

The most successful companies are the ones where "the Boss" can do the job of every man jack under him, and the workers know it. To draw an analogy: When you visit your doctor, you have a medical tech confirm your appointment and verify your insurance information; you have a nurse ask you some questions and take your vitals (weight, BP, temp); and the doctor does the actual diagnosis and recommends treatment. The nurse can do everything the tech does, but has specialized knowledge and experience that the tech does not have; so it is more efficient to let the nurse do only the things the tech cannot do. Similarly, the doctor has a level of training, knowledge and experience the nurse does not; while the doc could take your vitals, most of the time it is better to have the nurse do that and free up the doctor's time for doing things that only the doctor can do.

You clearly express your opinion that techs possess a subset of the skills nurses have and nurses possess a subset of the skills physicians have.

Hopefully the you will have been enlightened from the content of others' posts that to accomplish a complicated task such as providing healthcare, while individuals' skill-sets may somewhat overlap, physicians do not have all the skills of nurses and techs. I.e., even if they had the time, physicians alone could not provide the same standard of care as a combination of physicians, nurses and techs do, because each has skills and abilities the others do not.

I find the following statement of yours ironic given that you accuse me of mis-representing your opinion.

This was in response to your assertion that the highly-paid people in a firm don't deserve to be paid much more than the lowest-paid. I used a medical clinic as an example of why there are tiers of compensation, which reflect the relative value of a person to the firm.

Which is presumably referring to my idea of limiting the CEO's pay to TEN TIMES the pay of the lowest paid worker in her organisation. If I earned ten times what you do, would you think I earned "much more" than you?

Please feel free to put me on your ignore list.

<snip>

Ivor, running away from a discussion you were failing in just to try to recruit others who weren't involved for help in taking ad-hominem potshots at your opponent from a safe distance is not only disgusting, but also just pathetic and lame.

What makes you think I've "run away" from the other thread? Is there a time limit between making posts to a thread I've exceeded?

Please learn what an ad-hominem attack is before you accuse me of performing one on my opponents.

The reason I started this particular thread is because it was apparent from the comments of posters in the other thread that many more people other than Miss_Kitt think physicians have the all skills, ability and knowledge necessary to practice medicine without the help of others with different sets of skills, abilities and knowledge. Hopefully the posts by physicians such as Dr. Imago and TAM will have educated them this is not the case.

[Cavemonster]

Ivor-
The question people have answered in this thread is more along the lines of "Can a single doctor serve patients with no help" and the answer is an obvious no. This in no way reflects Miss Kitt's statement.

Posters to the thread, wishing to address the actual point of contention will answer this question.

"In a pinch, Doctors could perform all the essential duties of nurses with little or no extra training, but Nurses could not perform all the essential duties of a Doctor without extensive extra training. Is this true?"

[Wowbagger]

Next thing they're going to say is that pilots don't need their crew to do their jobs, either.

[SteveGrenard]

I am not sure if it is seen in the UK but this idea sounds as if it was inspired by the popular American TV show HOUSE (starring Brit actor Hugh Laurie faking an American accent). He and his fellow doctors do everything on the show. Doctoring, nursing, running labs, doing MRIs and CT scans, drawing blood .... and then even breaking into patients' homes to do an environmental check up. While some of the diagnostic problems are interesting this show is a farce that misleads people into believing doctors do all these things. From what I can see it just saves money on extras, that's about it. Otherwise it is totally unrealistic as is the idea that highly trained physicians should be doing all the work nurses and techs or other ancillary personnel do.

I'd like to see the doctors I work with hook up a patient and intently watch them all night while they're having a sleep study or tweak their ventilators based on blood gases. There are protocols for this, the doctors can be freed to do more important work. In fact until there were therapists, techs and technologists created to do these things it just didn't happen except on occasion for research. There is just too much work, much of it technical, that needs to be done and well trained and highly paid physicians would, as others have said, be a complete waste of resources and a doctor's time if they had to do all this themselves.

[borealys]

The most successful companies are the ones where "the Boss" can do the job of every man jack under him, and the workers know it. To draw an analogy: When you visit your doctor, you have a medical tech confirm your appointment and verify your insurance information; you have a nurse ask you some questions and take your vitals (weight, BP, temp); and the doctor does the actual diagnosis and recommends treatment. The nurse can do everything the tech does, but has specialized knowledge and experience that the tech does not have; so it is more efficient to let the nurse do only the things the tech cannot do. Similarly, the doctor has a level of training, knowledge and experience the nurse does not; while the doc could take your vitals, most of the time it is better to have the nurse do that and free up the doctor's time for doing things that only the doctor can do.



"In a pinch, Doctors could perform all the essential duties of nurses with little or no extra training, but Nurses could not perform all the essential duties of a Doctor without extensive extra training. Is this true?"

I suspect most doctors would need some extra training to do the work most nurses do, but not nearly as much extra training as would be needed in the reverse situation.

To say that techs do a subset of the nurse's work is just not correct, however. Techs specialize. Most nurses I know can run a few basic diagnostic machines in a pinch, but I've never met one who could perform, say, a cardiac ultrasound or a videofluoroscopy. For that matter, most doctors I've met would have trouble if they were asked to actually use the machines. It's not a tech who books the appointment and verifies the information; that would be a waste of their training. That's a receptionist or clerk's job. Which a doctor or nurse with adequate organizational skills could certainly do if they had to, though there's no guarantee that they've got those skills. (I have enough trouble keeping my own caseload straight; no way could I manage the schedule for my whole office!)

Working as an allied health professional, I've quickly learned that there are a lot of things doctors simply cannot do by themselves -- doctors are people too, after all, and do we really expect them to know everything? That's why we have as many varieties of specialists as we do. Strictly speaking, no one doctor could do the jobs of nurse, physio, OT, respiratory therapist, speech pathologist, dietician, audiologist, optometrist, social worker, psychologist, lab tech, x-ray tech, ultrasound tech, pharmacist and clerk -- no one person has the time to learn the material for all of those jobs, much less to actually do them.

Any clinic that doesn't have all of those people on staff is necessarily limited in the services they can offer. My doctor works in a clinic that has only doctors and nurses. They outsource everything else, from blood tests to psych evaluations to physiotherapy. I work in a clinic that offers various health-related testing and therapies but has no doctor on staff. We don't offer medical services.

The question of which staff are "necessary" to the operation of a clinic depends entirely on what kind of clinic it is.

I don't think Miss Kitt meant quite what Ivor claimed she did, but the analogy really only works on the most superficial level.

[Cavemonster]

I suspect most doctors would need some extra training to do the work most nurses do, but not nearly as much extra training as would be needed in the reverse situation.

To say that techs do a subset of the nurse's work is just not correct, however. Techs specialize. Most nurses I know can run a few basic diagnostic machines in a pinch, but I've never met one who could perform, say, a cardiac ultrasound or a videofluoroscopy. For that matter, most doctors I've met would have trouble if they were asked to actually use the machines. It's not a tech who books the appointment and verifies the information; that would be a waste of their training. That's a receptionist or clerk's job. Which a doctor or nurse with adequate organizational skills could certainly do if they had to, though there's no guarantee that they've got those skills. (I have enough trouble keeping my own caseload straight; no way could I manage the schedule for my whole office!)

Working as an allied health professional, I've quickly learned that there are a lot of things doctors simply cannot do by themselves -- doctors are people too, after all, and do we really expect them to know everything? That's why we have as many varieties of specialists as we do. Strictly speaking, no one doctor could do the jobs of nurse, physio, OT, respiratory therapist, speech pathologist, dietician, audiologist, optometrist, social worker, psychologist, lab tech, x-ray tech, ultrasound tech, pharmacist and clerk -- no one person has the time to learn the material for all of those jobs, much less to actually do them.

Any clinic that doesn't have all of those people on staff is necessarily limited in the services they can offer. My doctor works in a clinic that has only doctors and nurses. They outsource everything else, from blood tests to psych evaluations to physiotherapy. I work in a clinic that offers various health-related testing and therapies but has no doctor on staff. We don't offer medical services.

The question of which staff are "necessary" to the operation of a clinic depends entirely on what kind of clinic it is.

I don't think Miss Kitt meant quite what Ivor claimed she did, but the analogy really only works on the most superficial level.

I think Miss Kitt was pretty clear that she wasn't talking about specialized technicians-
"techs" (by which I mean the medical office assistants, not the technicians who run specific imaging equipment);

Miss Kitt's argument was that Doctors offer a skill set that justifies a significantly higher pay rate than nurses and office assistants. I find that hard to disagree with with.

[jhunter1163]

Miss Kitt's analogy isn't a very good one, but that doesn't invalidate her basic argument, and to argue that it does is just plain wrong.

[cj.23]

Miss Kitt's argument was that Doctors offer a skill set that justifies a significantly higher pay rate than nurses and office assistants. I find that hard to disagree with with.

Ah, well remuneration is in no way based upon skill set in any job. :( However doctors take at least seven years of academic study, to a British nurses three years of formal academic study, before qualifying. Pharmacists need one year pre-degree, a four year degree. All need at least one year post reg as I recall. Pharmacy Technicians get three to four years - Radiographers have a high degree of training as well, as do anesthetists, vets, dentists -- and especially psychiatrists. It seems entire reasonable that the length of vocational training and expertise should be reflected in final salary - so docors might earn 2.5 to 3 times more than nurses, and maybe twice what a pharmacy tech gets, but slightly less than a vet (who has a longer training programme). Of course it soes not an dnever will work like that- to attract the kind of people capable of being doctors requires at least in theory high salaries, though I'm not convinced - I think any doctor I have ever met could earn more in the city, industry or another sector - and market forces mean that for example in the 1980's we had a net loss of NHS staff to America, where they could expect greater earning potential, especially among our nurses, so wages are high to maintain a very valuable resource.

cj x

[SYLVESTER1592]

Ah, well remuneration is in no way based upon skill set in any job. :( However doctors take at least seven years of academic study, to a British nurses three years of formal academic study, before qualifying. Pharmacists need one year pre-degree, a four year degree. All need at least one year post reg as I recall. Pharmacy Technicians get three to four years - Radiographers have a high degree of training as well, as do anesthetists, vets, dentists -- and especially psychiatrists. It seems entire reasonable that the length of vocational training and expertise should be reflected in final salary - so docors might earn 2.5 to 3 times more than nurses, and maybe twice what a pharmacy tech gets, but slightly less than a vet (who has a longer training programme). Of course it soes not an dnever will work like that- to attract the kind of people capable of being doctors requires at least in theory high salaries, though I'm not convinced - I think any doctor I have ever met could earn more in the city, industry or another sector - and market forces mean that for example in the 1980's we had a net loss of NHS staff to America, where they could expect greater earning potential, especially among our nurses, so wages are high to maintain a very valuable resource.

cj x
Besides the training, another reason why doctors can have a reasonable salary, is because they work a lot of hours, and often have irregular hours, night shifts (which often pays better), or have to be on call. Or they have a honorarium and they get paid for the work they do, the number of patients they treat. If it were a 9 to 5 job, paid by the hour, in most cases their income really wouldn't be something you would be impressed by if you compare it to the avarage manager or executive.

SYL :)

[cj.23]

Besides the training, another reason why doctors can have a reasonable salary, is because they work a lot of hours, and often have irregular hours, night shifts (which often pays better), or have to be on call. Or they have honorarium and they get paid for the work they do, the number of patients they treat. If it were a 9 to 5 job, paid by the hour, in most cases their income really wouldn't be something you would be impressed by if you compare it to the avarage manager or executive.

SYL :)

Yep, true enough - but equally true of many health care professionals. I know many nurses and techies who are working as we speak - but generally in the UK these positions are salaried, so one gets the salary, without much in the way of antisocial hours pay, overtime, etc. I don't think in the two countries where i have relevant experience - Denmark and the UK - I have ever met anyone who thinks GP's/MD's are overpayed for the work they do - in fact I think my greatest concern is the gap between Senior Hospital Consultants and Junior Doctors and community practice GP's. The front line troops are probably underpayed. :( I'd grouch about Nursing pay but in the uK it has been brought greatly in to line with other public sector jobs, and pharmacists recieve very good pay- though dispensers and technicians are generally badly underpaid from the ones I know.

Anyway here's my very best to the awesome doctors (and nurses etc, etc! out there! If it was not for rapid treatment a week or so back and a dose of antibiotics i might very well not be here - my aunt died at 21 of pleurisy turning to pneumonia, and i am bvery glad I live in an age when that can be prevented, as it was in my case. :) :)
cj x

[SYLVESTER1592]

Anyway here's my very best to the awesome doctors (and nurses etc, etc! out there! If it was not for rapid treatment a week or so back and a dose of antibiotics i might very well not be here - my aunt died at 21 of pleurisy turning to pneumonia, and i am bvery glad I live in an age when that can be prevented, as it was in my case. :) :)
cj x

Glad to have you here :) I hope you have a speedy recovery :)

[borealys]

I never meant to argue that doctors shouldn't make more money because they have more specialized skills. I didn't actually read the other thread, so I don't know where the argument's gone there.

What a person's skills are worth shouldn't really depend on whether they can do everyone else's job or not. I've yet to meet a doctor who could do my job, but that's not relevant. I wouldn't argue that as a reason why I should earn as much as they do. I shouldn't, and there are a couple of reasons for that. For one, the doctors have more years of education than I do, and had to go through longer internship cycles. On that level, it seems only fair that they should earn a bit more. More important, in my view, is the level of responsibility our respective jobs entail.

The assorted specialists who work with patients have limited responsibility for their care. For instance, I do swallowing assessments in hospitals. If a patient of mine dies from a choking incident or aspiration pneumonia, it's my problem. If they die from anything else, it isn't, and I may not even be told the details. Doctors don't have that kind of limitation on their responsibility to their patients. If something goes wrong, no matter what it is (with the exception of some specific kinds of errors on the part of the other staff), the doctor is the one it comes back to.

It's a heavy responsibility, and one that should never be undervalued.

Whether that argument holds true by analogy in the business world can be debated (and maybe is already being debated) elsewhere.

(Of course, the medical system would absolutely fall apart without nurses, and the way nurses around here are overworked and underpaid is shameful, but that's a whole different issue for another thread and another day.)

For the record, I'm a speech-language pathologist. :)

[Physiotherapist]

Yep, true enough - but equally true of many health care professionals. I know many nurses and techies who are working as we speak - but generally in the UK these positions are salaried, so one gets the salary, without much in the way of antisocial hours pay, overtime, etc. I don't think in the two countries where i have relevant experience - Denmark and the UK - I have ever met anyone who thinks GP's/MD's are overpayed for the work they do - in fact I think my greatest concern is the gap between Senior Hospital Consultants and Junior Doctors and community practice GP's. The front line troops are probably underpayed. :( I'd grouch about Nursing pay but in the uK it has been brought greatly in to line with other public sector jobs, and pharmacists recieve very good pay- though dispensers and technicians are generally badly underpaid from the ones I know.

Anyway here's my very best to the awesome doctors (and nurses etc, etc! out there! If it was not for rapid treatment a week or so back and a dose of antibiotics i might very well not be here - my aunt died at 21 of pleurisy turning to pneumonia, and i am bvery glad I live in an age when that can be prevented, as it was in my case. :) :)
cj x


Yes, nurses are paid a basic wage, but nurses in the UK receive extra duty payment for working shifts. Some hospitals still have Early, Late and Night shifts, whereas some have gone to 12 hour shifts, but where nights are worked, there is a lot of extra duty payment to be claimed and also on a late shift, with no so much or any on an early shift.

Lots of nurses work long hours just as much as doctors do, although not all are 'on call' in the same way, although some specialist nurses are as well as midwives.

[T.A.M.]

The issue of pay is a completely different kettle of fish. There are many reasons the pay differential is as it is. Some of it may be (MAY BE) due to the greater amount of education.

To be a physician in Canada you require a 4 year bachelor degree minimum for ENTRY to medical school. It is competitive enough that many, many applicants have their masters (an additional one to two years) some even with their PhD prior to acceptance at medical school. The MD program is then typically 4 years (2-3 didactic, 1-2 Clinical), followed by a 2-6 year residency where you learn by doing, with varying degrees of independence as you move on. Add it up. I personally had 11 years of post secondary education before I began my own practice, and I am a GP, imagine for a surgeon or other.

A nurse, at least here in Canada, can get into Nursing school with 2 years of University. Their program is then typically 2-3 years more, for a total of 4-5 years Post secondary education.

So the typical physician loses almost all of his/her 20's in terms of earning. A nurse loses about 1/3rd to 1/2.

As well, the level of culpability or ultimate responsibility. Yes, it is true, that if a Nurse gives out too much of a medicine, and the patient gets ill or dies, they are to blame, but for that to happen, they have to misread or misinterpret a physician order. However, if a diagnosis is missed, the MD is responsible. If a medicine is misordered, the MD is responsible. If a procedure goes wrong, such as a Subclavian line insertion, or lets say an air embolus from the removal of said line, an MD is to blame. If a depressed patient comes to the office, and you fail to ask if they are suicidal, and the kill themselves, and MD is to blame.

So some of the wage difference may be the amount of ULTIMATE responsibility in terms of patient outcome.

Another reason, one that I actually put less stress on, is the hours of work. A physician, if he IS NOT WORKING THROUGH THE HOSPITAL, actually often works roughly the same hours as a nurse. If he/she does work more, it is likely voluntary, in order to complete the MASSIVE amount of paper work they receive everyday.

A doctor that works as a specialist with the hospital likely works horrible hours. A typical work day for a surgeon, for instance, is 7AM start, 7PM finish, with usually 1 in 4 to 1 in 5 call. That means every 4 to 5 days, the surgeon not only works the 12 hour day I just mentioned, but is also on call the entire night, and then also works the 12 hour day mentioned, the NEXT day. This happens, as said once every 4-5 days, but the 12h day is all week long, at least Mon-Fri, sometimes weekends too. That work will often mean life saving surgery, with 2-7 hours at a time of STANDING over a patient, working with fine tools, tying off arteries, cutting away tissues, cutting out tumors, the list goes on.

I know I ramble, but the pay issue is simply a stupid one. Do nurses deserve more pay than they are getting? Depends on where they work, where they live, but for the most part, yes they do. Do they provide knowledge set, skill set, and provide the hours that go into (along with other factors) what creates a physician's salary/wages...doubtful.

This is not to belittle nurses, as I do think they play a VITAL role in health care.

TAM:)

[Dr. Imago]

Your patient is a man with end stage liver cirrhosis on the high urgency list for a transplant. He has a Hb of 4.7 in an arterial bloodgas taken by the ICU nurse. You have instructed her not to give blood without conferring first and to call if Hb drops any further.
The ICU nurse decides otherwise guided by protocol that says the patient in question should have an Hb of 5 and gives 2 bags of filtered erythrocytes. She doesn't tell you, her shift ends long before yours does and she goes home. A liver is found and the transplantation team has been called in by your collegue, who also does the pre-op assesment. He calls you to confer and you find out that the patient has recieved 2 packed cells, has a high INR and prolonged APTT, for wich some fresh frozen plasma was given, no signs of acute bleeding, further bloodwork is on the way and the department of hepatology has been consultated for the immunosuppression therapy. Blood has already been ordered and the level-one is prepared. Transplantation is planned 1,5 hours from now. The professor of hepatology who is part of the team now calls you after he found out the patient had 2 packed cells and starts telling you how it will be your fault if the liver is rejected.
What do you do?
a. tell the professor of hepatology to "take a chill pill"
b. tell on the nurse who gave the packed cells
c. sit there and let the professor unload his frustration on you and sulk afterwards while taking the blame.

This is an excellent post, Sylvester. And, it should probably go more into the other thread discussing why "protocols" and "checklists" can sometimes do more harm than good.

Yes, some nurses clearly overstep their bounds and ignore orders (we have a joke in my hospital that lately they're not really "orders" but, instead, "suggestions"), and often the hubris of not knowing what you don't know and disobeying a clearly prescribed course of specific action for a specific patient to "follow a protocol" that subsequently, at least in this case, precluded this patient from getting a new liver.

That nurse, in my opinion, should have to answer to the head of hospital nursing, all the physicians in charge of that patient's care, the state nursing board, and probably to the courts (at least in the U.S.) if that patient dies waiting for another liver. But, it sometimes amazes me the errors we'll let slide with nurses that we would otherwise crucify physicians for. This would be one of those instances.

But, I still can't be at the bedside 24/7/365. I have to trust that my "eyes and ears" will do what I request of them, and keep me informed. Still, I too have stories of flat out refusal to provide care (under the guise of "advocating for the patient" when, in fact, it was the nurses ignorance of the treatment), giving narcotics that were not in fact ever prescribed because the patient was perceived to be in pain (and it almost killed the patient), and a whole host of others. However, I also have stories of nurses saving my butt on other occassions too.

~Dr. Imago

[Dr. Imago]

Lots of nurses work long hours just as much as doctors do, although not all are 'on call' in the same way, although some specialist nurses are as well as midwives.

We don't work "shifts" in that we always get to come in at 7:00 AM and when 3:00 PM comes around, we don't have relief coming in and we get to go home. Also, we don't get an hourly wage, and are paid overtime if we are asked to work over that wage. Also, we don't make the same amount of money if we're taking care of four patients or one patient, depending on how busy our census is and what assignment we've been given. Most nurses either work five "8's" or three "12's" (i.e., 40-hour or 36-hour work week). If they go over that alloted time, or work unusual hours, they get overtime or differential pay.

I come into the hospital at roughly 6:00 AM every morning. I leave when the work is done, whenever that may be. Sometimes that 3:30 PM, sometimes that's 8:00 PM. On average, I work at least a 60-hour week. Sometimes I work a 75-80 hour week. My pay doesn't change. I do this at least 5 days a week, and that includes at least one 24-hour in-house call. I'm on usually 2 weekends a month (either a Friday 24-hour call, or two back-to-back Saturday/Sunday day or night calls).

Most nurses do not work long hours like doctors. Most of them also do not want my lifestyle. Trust me.

~Dr. Imago

[T.A.M.]

We don't work "shifts" in that we always get to come in at 7:00 AM and when 3:00 PM comes around, we don't have relief coming in and we get to go home. Also, we don't get an hourly wage, and are paid overtime if we are asked to work over that wage. Also, we don't make the same amount of money if we're taking care of four patients or one patient, depending on how busy our census is and what assignment we've been given. Most nurses either work five "8's" or three "12's" (i.e., 40-hour or 36-hour work week). If they go over that alloted time, or work unusual hours, they get overtime or differential pay.

I come into the hospital at roughly 6:00 AM every morning. I leave when the work is done, whenever that may be. Sometimes that 3:30 PM, sometimes that's 8:00 PM. On average, I work at least a 60-hour week. Sometimes I work a 75-80 hour week. My pay doesn't change. I do this at least 5 days a week, and that includes at least one 24-hour in-house call. I'm on usually 2 weekends a month (either a Friday 24-hour call, or two back-to-back Saturday/Sunday day or night calls).

Most nurses do not work long hours like doctors. Most of them also do not want my lifestyle. Trust me.

~Dr. Imago

Heh, I worked your lifestyle for 3 years in a rural community. I worked 60-80h per week, 1 in 3 on call, in the middle of butt **** nowhere with NO SPECIALISTS in house. The nearest center that had any specialists was 2 hours away. As a GP I had to admit, treat, and care for MI's, CHF, Emergency Trauma (unless so severe that we medivaced them out), in addition to my shifts in the ER, and my 5 clinics per week.

I say all this, because after 3 years of it, I had enough. I DO NOT WANT YOUR LIFESTYLE anymore, and I greatly appreciate your sticking it out.

I now run a busy but manageable family practice in an urban center, that allows me 40-50 hours per week, and all weekends off.

I HEAR YA!

TAM:)

[Ivor the Engineer]

<snip>

I come into the hospital at roughly 6:00 AM every morning. I leave when the work is done, whenever that may be. Sometimes that 3:30 PM, sometimes that's 8:00 PM. On average, I work at least a 60-hour week. Sometimes I work a 75-80 hour week. My pay doesn't change. I do this at least 5 days a week, and that includes at least one 24-hour in-house call. I'm on usually 2 weekends a month (either a Friday 24-hour call, or two back-to-back Saturday/Sunday day or night calls).

<snip>

Do you enjoy your job?

[Physiotherapist]

One other thing that I would like to point out is that people go into the healthcare profession for different reasons. Some want to be doctors from the get go, so they go the med school and that is fine. Others have always wanted to be nurses and perhaps want that patient contact more, so they will go to nursing school and that is okay too. By doing what they are doing, they are being educated in the best way possible to be able to achieve the skill set that they need when they graduate and start work. Doctors and nurses use different skills and are educated as such and they need each other.

I do have one friend however, who initially trained as a nurse. She graduated and then worked in a hospital setting, specialising and then gaining a BSc and then an Msc over about a 10 year period. After this, she still wanted more, so she applied to med school and got in and now works as a GP.

[T.A.M.]

of course. Most nurses I talk to say they wouldn't want my job, and I personally wouldn't want theirs.

Your friend sounds like a friend of mine who became a pharmacist, and now is bored and wants to be a lawyer instead...lol

TAM:)

[Camillus]

In the NHS, if there were no nurses, it would collapse, which is why nurses are prohibited from striking.

Nurses in the UK aren't prohibited from striking. Up until the late 90s (IIRC) the Royal College of Nursing (RCN) had a no strike policy but it dropped that under pressure from the membership. The other, smaller, nursing union* has always had a policy allowing strikes and I can remember covering for colleagues who were on the picket line several times in the 80s and 90s.

*The RCN is a sort of bastard mix of professional college and trade union. This often causes confusion. Unlike the medical colleges you don't need to sit exams to join the RCN.

[Dancing David]

From a layman's perspective, who worked as a mental health professional, and spent 1 1/2 years doing call work in the ED (crisis screening).

One of the reasons doctors get paid what they do is responsibility the buck stops with them.

Liability is the other word, if I was involved in a mess up, then my name would have been way low on the list. (In fact as an MHP I probably would not have been on the list)

However if I gave medical advice I would have been in deep poop.

[Ivor the Engineer]

I'm not sure responsibility and liability are the main reasons physicians are paid so well. For example, air traffic controllers are not as well remunerated as well as physicians, yet one could argue the individual level of responsibility and liability if things go wrong are similar between the two professions.

http://www.payscale.com/research/US/Job=Air_Traffic_Controller/Salary

http://www.payscale.com/research/US/People_with_Jobs_as_Physicians_%2F_Doctors/Salary

I'd imagine the main reason physicians are generally* paid as well as they are is because of limited supply and huge demand.

*Yes, I realise not all physicians get paid particularly well, but as a group they are doing pretty good.

[tomwaits]

I'd imagine the main reason physicians are generally* paid as well as they are is because of limited supply and huge demand.



You would be correct in that assumption. Pretty much everybody needs medical treatment, but there are so few of them. I'm not sure how it works in the UK, but in the US the American Medical Association essentially acts as a modern day guild, restricting the amount of people who can become doctors each year, which drives up the cost.

[jj]

In a discussion I'm having over in the Business and Economics sub-forum a couple of posters have expressed their opinion that physicians do not require nurses and techs to perform their job. E.g.,

http://forums.randi.org/showpost.php?p=4369287&postcount=74

I was wondering what other posters may think about this idea?

:)

To the OP title, the answer is "only if the doctor is willing to spend 24/7 with the patient, alert and ready to act".

Somebody is talking out of their hat.

[T.A.M.]

You would be correct in that assumption. Pretty much everybody needs medical treatment, but there are so few of them. I'm not sure how it works in the UK, but in the US the American Medical Association essentially acts as a modern day guild, restricting the amount of people who can become doctors each year, which drives up the cost.

Interesting. Here in Canada, as far as I know, it is not our association (the CMA) but rather individual medical schools that restrict the number of entrants, and this tends to be based on cost to train more than anything. I would like to see the evidence that it is the AMA that restricts doctor numbers.

As for supply and demand, that is true to a degree. It is less so in urban centers, and more so in rural areas, at least here in Canada. That said, the fee codes are a provincial domain here in Canada.

TAM:)

[Dancing David]

You would be correct in that assumption. Pretty much everybody needs medical treatment, but there are so few of them. I'm not sure how it works in the UK, but in the US the American Medical Association essentially acts as a modern day guild, restricting the amount of people who can become doctors each year, which drives up the cost.

:) Source and data please? :)

[Psi Baba]

Nurses and techs do everything anyway. Doctors do very little; as little as they can get away with. Nurses also pick up on way more about the patients than doctors do because they are too busy trying to move on to the next patient. Doctors would be completely lost without a strong support staff, because by and large they often lack common sense. The latest development is that doctors no longer travel to hospitals to see their own patients. There are specialized doctors called "hospitalists" to do that for them. What a joke.

[SYLVESTER1592]

Nurses and techs do everything anyway. Doctors do very little; as little as they can get away with. Nurses also pick up on way more about the patients than doctors do because they are too busy trying to move on to the next patient. Doctors would be completely lost without a strong support staff, because by and large they often lack common sense. The latest development is that doctors no longer travel to hospitals to see their own patients. There are specialized doctors called "hospitalists" to do that for them. What a joke.
Please indicate this conviction at every instance from the start to any doctor who offers to treat you and at every hospital visit indicating your preference for a nurse or tech to handle your case, objecting to a doctors interference at any time if this is your wish. If you can, put it in writing please, I know I would.

SYL :)

[T.A.M.]

Nurses and techs do everything anyway. Doctors do very little; as little as they can get away with. Nurses also pick up on way more about the patients than doctors do because they are too busy trying to move on to the next patient. Doctors would be completely lost without a strong support staff, because by and large they often lack common sense. The latest development is that doctors no longer travel to hospitals to see their own patients. There are specialized doctors called "hospitalists" to do that for them. What a joke.

you are full of crap.

TAM:)

[Dr. Imago]

Do you enjoy your job?

Most of the time, yes. It's far more interesting and entertaining, and far more rife with frustrations and challenges, than any other job I've had prior. And, a lot of times it's very fun and rewarding to help people who genuinely want and appreciate what you can do for them.

For instance, today I helped a patient get through a surgery without nausea and vomiting, something that she'd had in every surgery up to this point. She has to come back in two weeks for a repeat procedure on the contralateral body part, and she asked me before she left to give her anesthesia again.

And, Psi Baba... all I can say is that a lot of very misinformed people feel the same way as you because that's all they perceive the doctors to be doing in the hospital on the wards, when they have no actual idea what it is we really do. So, if you really feel that you want a nurse in charge of your care during a hospitalization, you'll simply have to take my word that you have no idea how misinformed you are. :)

~Dr. Imago

[Groovydoc]

Nurses and techs do everything anyway. Doctors do very little; as little as they can get away with. Nurses also pick up on way more about the patients than doctors do because they are too busy trying to move on to the next patient. Doctors would be completely lost without a strong support staff, because by and large they often lack common sense. The latest development is that doctors no longer travel to hospitals to see their own patients. There are specialized doctors called "hospitalists" to do that for them. What a joke.


Damn, 4 years of college, 4 years of med school, 3 years of residency, more than 5 years in practice as a hospitalist in a rural hospital, on call 182.5 days a year, and now I realize its all a joke! If only the great nurses and techs I work with (not sarcasm) had told me, I could have gotten a lot more rest.

And I'm sure all the lazy docs whose patients I see in the hospital just want to spend their spare time playing golf (there's sarcasm) instead of having to cram 25+ patient visits a day in to keep their office afloat due to HMO/medicare generosity (again sarcasm).

I will agree that no doc wants to be without a strong support staff. For the rest, TAM said it best.

[ArmillarySphere]

My father, who is about to retire as a GP, certainly appreciates the value of an experienced and skilled nursing staff - he'll sing their praises given half a chance. Ditto for his PT; the two of them made a pretty astonishing tag team.

Anecdotally, when I was being treated at his clinic, it's the first time I had blood drawn when I had to look to be able to tell that it was being done. Didn't feel a thing from start to finish.

That said, there are good reasons why MDs are paid more than nurses. Here in Sweden, I would argue that the orderlies are pitifully underpaid, given that it's a pretty physically arduous job, nurses less so, and MDs are pretty alright.

[T.A.M.]

My father, who is about to retire as a GP, certainly appreciates the value of an experienced and skilled nursing staff - he'll sing their praises given half a chance. Ditto for his PT; the two of them made a pretty astonishing tag team.

Anecdotally, when I was being treated at his clinic, it's the first time I had blood drawn when I had to look to be able to tell that it was being done. Didn't feel a thing from start to finish.

That said, there are good reasons why MDs are paid more than nurses. Here in Sweden, I would argue that the orderlies are pitifully underpaid, given that it's a pretty physically arduous job, nurses less so, and MDs are pretty alright.

Your mention of blood being drawn for some reason reminded me of another point.

In hospital (or outside for that matter), When a given procedure can't be done by the person who normally does it, who do you think is called up, expected, to do it? The MD.

Can't get that IV nurse? Call the MD. Can't get that blood gas Tech? No problem, the Staff guy, or one of his underling Interns/Residents (also MDs), will get it. Patient has spider veins and not a single nurse or tech can get blood from that cubital fossa...not to worry, the MD will be right up with a butterfly needle and a few tubes.

does it happen all the time? No, of course not, but from my experience both as a resident, and as a GP working in a rural hospital, the MD is always the guy (or gal) who ends up performing the task no one else can get done.

TAM:)

[pgwenthold]

T.A.M.'s comments lead me into mine, which are somewhat related:

My wife is a veterinarian. While she focuses on doing the doctor work, she can easily handle all the other roles in the vet clinic, including veterinarian technician. Most of the time, the techs do things like give shots and take blood and other samples. But, as TAM notes, when they have a problem, they go to the vet, and she is the one who does it. She has better technical skills than most of the vet techs she works with. She can also do the in-house labwork and pathology.

I should note she can also handle roles including janitor, laundry, kennel cleaner, and even receptionist/cashier.

I realize it is not the same as human physicians/nurses/techs, but I just wanted to mention the extent of what they are capable of doing.

Not only are veterianarians capable of doing vet tech work, they are generally the ones who teach vet tech classes.

[Dancing David]

Nurses and techs do everything anyway. Doctors do very little; as little as they can get away with. Nurses also pick up on way more about the patients than doctors do because they are too busy trying to move on to the next patient. Doctors would be completely lost without a strong support staff, because by and large they often lack common sense. The latest development is that doctors no longer travel to hospitals to see their own patients. There are specialized doctors called "hospitalists" to do that for them. What a joke.

Wow, so many strawmen and fallacies in one post. there are some doctors who are not good, just as there are many people who are not good at what they do.

I suppose you get your data from some source.

My sample with doctors is about thirty in professional capacities. Ten were ED doctors I worked with, doing psych screenings. the erst were psychiatrists I talked to in one capacity or another.

My sample must have had a lot of competant doctors and be biased. In the opposite direction of your sample, of course.

[Dancing David]

Can't get that IV nurse? Call the MD. Can't get that blood gas Tech? No problem, the Staff guy, or one of his underling Interns/Residents (also MDs), will get it. Patient has spider veins and not a single nurse or tech can get blood from that cubital fossa...not to worry, the MD will be right up with a butterfly needle and a few tubes.


TAM:)

Wow, arterial sticks, I have known many nurses who refused to do the, and some blood techs. The MD got it a lot of the time.

Now I would rather have an experienced blood tech draw my blood any day, over an MD or a nurse, usually hurts less and goes faster. Just like anything paractice helps.

[I Ratant]

There aren't enough doctors to fill the void were all the help to disappear.
The doctors can do the diagnosing, the help does the dirty work.
Lots of patients keep the sawbones -and- the help fully engaged.
Using a tv mellerdramer as an indication of -anything- that relates to reality, and House would be one of the worst, is simplistic.

[balrog666]

you are full of crap.

TAM:)


http://forum.darwincentral.org/images/smilies/hesaid.gif

[Physiotherapist]

Your mention of blood being drawn for some reason reminded me of another point.

In hospital (or outside for that matter), When a given procedure can't be done by the person who normally does it, who do you think is called up, expected, to do it? The MD.

Can't get that IV nurse? Call the MD. Can't get that blood gas Tech? No problem, the Staff guy, or one of his underling Interns/Residents (also MDs), will get it. Patient has spider veins and not a single nurse or tech can get blood from that cubital fossa...not to worry, the MD will be right up with a butterfly needle and a few tubes.

does it happen all the time? No, of course not, but from my experience both as a resident, and as a GP working in a rural hospital, the MD is always the guy (or gal) who ends up performing the task no one else can get done.

TAM:)


I really don't think that this is quite fair and it works both ways too.

I have seen some nurses (RN's) who are absolutely fantastic at taking blood and better than some of the doctors - the one I am thinking of had experience of working on renal wards and never missed. She could also cannulate well too.

In the UK, rather than Interns and Residents we used to have SHO's, Registrars, Senior Registrars and Consultants. They are now F1's and F2's with Registrars and Consultants. I worked with one Registrar who was absolutely appalling at taking blood and inserting cannulas. He would go along and have three goes and still would not be able to get the cannula in. He went off and would leave the poor patient like a pin cushion. No one every wanted him to go anywhere near them.

This guy got the sack in the end, as when on call, he would never come and see a patient when requested until they were near to arrest.

As someone else said, there are some excellent doctors and then some not so good ones, just as there are nurses.

[Professor Yaffle]

When a nurse was having difficulty taking blood from my son, as a baby, she called a doctor, who also couldn't do it, then they called a more experienced nurse who had no problem.

[T.A.M.]

I really don't think that this is quite fair and it works both ways too.

I have seen some nurses (RN's) who are absolutely fantastic at taking blood and better than some of the doctors - the one I am thinking of had experience of working on renal wards and never missed. She could also cannulate well too.

In the UK, rather than Interns and Residents we used to have SHO's, Registrars, Senior Registrars and Consultants. They are now F1's and F2's with Registrars and Consultants. I worked with one Registrar who was absolutely appalling at taking blood and inserting cannulas. He would go along and have three goes and still would not be able to get the cannula in. He went off and would leave the poor patient like a pin cushion. No one every wanted him to go anywhere near them.

This guy got the sack in the end, as when on call, he would never come and see a patient when requested until they were near to arrest.

As someone else said, there are some excellent doctors and then some not so good ones, just as there are nurses.

My point was not who was better at a given item. Certainly there are many nurses, those in the renal dialysis wards, the hem/onc wards, etc, who could thread a needle in terms of cannulation. Same goes for resp techs and arterial blood gases.

My point was, that when these people cannot get the job done, when the cannula still is not in, the blood gas not drawn, because these experts cannot get it...who is called???

in my experience, the buck always stops with the MD. Trust me, I have lived it.

TAM:)