Blog Post Focus
This blog post is about my experience with many people in healthcare being unaware of the differences of each field and training. In particular, this explores how my medical school often promoted a view of all members being equal and downplaying different experiences in education and training among different providers in the healthcare team. This is a shame and diminishes the importance of each field and downplays the importance of medical training and physicians in the healthcare team.
Personal Experience with My Medical School and Other Providers Being Unclear –or Unaware—of the Differences Among Providers
Learning Skills from Non-Physicians
At medical school I recall many experiences where nurses would come in and teach things like how to place an NG tube or a foley catheter. Paramedics would come in and teach CPR, intubation, and go over simulations. An ultrasound tech went over principles of ultrasound. At each moment of hands-on learning it seemed that we were expected to learn everything from non-physicians. It created an odd dynamic and it made me wonder when I would learn things from physicians.
Querying Nurses—“More Training”
I asked nurses when they came in for such teaching experiences their understanding of the differences of education between physicians and nurses. Universally the reply is that it is “the same, but physicians get more training.”
Multi-Disciplinary Events to Equate Physicians with Nurses and Other Care Team Members
Also, the medical school hosted several multi-disciplinary events to describe how each member of the care team are equal and that it is incorrect to think of the physician as the leader of the care team—generally led by non-physicians. If this narrative was questioned it was simply ignored or not addressed directly.
A Scary Equation and First Lessons
One of the first lectures in my medical school made me avoid primary care – because a physician in his lecture described the care of NPs and PAs to be essentially the same as physicians and in some instances better. What a scary lecture!
One of the first things taught was that the time and effort of medical school was essentially equal to and replaceable by completely different training conditions. I was not the only medical student who was shocked and upset at this lesson and the proceeding lessons.
All the above to say that my medical school did nothing to really explain the training of physicians from non-physician providers or to solidify the roles each have. It seemed at times the medical school actively facilitated a narrative describing physicians as the same as any other provider.
Background Differences
Healthcare
Healthcare is any effort undertaken to promote or improve the health of a person. It generally is connotated to mean under the care of licensed health professionals, but also refers to efforts of individuals to improve their own health.
Medical Care
Medical care is directed by physicians. The role of physicians is to make medical decision making and recommend treatment. The role of other providers then is to follow the recommendation of the physician and to make use of their own decision-making capacity within their field if they have any.
For example, a physician may order physical therapy for a stroke patient with some impairment of ambulation. The physical therapist then enacts the therapy. They are able to use their own training to guide that therapy as needed. Another example: a physician orders blood pressure medication given at certain intervals during an inpatient stay. The nurse distributes these blood pressure medications as ordered.
So, healthcare and medical care are not synonymous. Anyone may partake in healthcare, but only physicians may direct medical care.
Training Differences Among Providers
Physicians do not just receive “more training” than other providers, they receive different training. The physician is not receiving nursing training. They are not receiving the training of a physical therapist. They are not receiving the training of an x-ray tech. Likewise, nurses do not receive medical training. Therapists do not receive medical training. Techs do not receive medical training.
Without going through medical school it can be difficult to understand all that medical training entails. The same for therapy, counseling, nursing, etc. However, it is not the level of training that differs between these disciplines. The training itself differs. Medical training prepares physicians to make medical decision making and enact those plans. Nursing training and other training are different fundamentally.
Final Thoughts on Medical School Doing a Poor Job of Explaining Differences Among Providers
My medical school didn’t explicitly mention the roles of different care team members. Maybe because they thought it was self-explanatory or maybe because they had more self-destructive intentions. It is hard to believe medical schools really want everyone to believe that physicians are the same as other providers, but my medical school did a good job of extending that point of view.
Providers Are Different
The training that each care team member receives is fundamentally different. The care that a physician is trained to give is different from that of a nurse and other care team member. A physician should not be doing the job of a nurse or therapist and neither should a non-physician do the work of a physician.
It is not a matter of volume of training that distinguishes physicians from other providers. It is a matter of the fundamental nature of that training. It is as simple as this: it is different training.