Thursday, June 22, 2017

RNs Vs. MDs

The American Medical Association (AMA) is essentially an organization of general and family practitioners. Most of the specialties have developed their own organizations--which often oppose each other and the AMA. As a result, the medical voice is often divided--and poorly heard. But, despite being the largest physician organization in the country, the AMA lacks a true public relations department that represents physicians, however narrow. Physicians are often portrayed negatively, with stories of narcotic abuse, greed and medical mistakes dominating the news. How could the anti-vaccine movement get a foothold anywhere physicians had a respected voice? Survey data from 2012 revealed that only 34 percent of Americans have “great confidence” in physicians, compared with 73% in 1966.

The same is not true for nurses. Nursing groups have had an ongoing public relations program for years and it has worked. According to the latest Gallup poll in 2014, over 80% of American state nurses have “very high” or “high” standards of honesty and ethics, while only 65% of Americans feel the same way about doctors. In Great Britain there are studies that show that the nurse is the lynch-pin of the health service's support.

In the U.S. nurses often pit themselves against physicians. The “ACNM Project,” launched by the American College of Nurse-Midwives, has focused on making nurse midwives the “norm for women’s health care service in the United States.” Their aggressive public relations campaign has been successful. Midwives attended 3% of births in 1989 compared with 10% today. Rather than show patients the benefits of their profession, however, they have focused on negative rhetoric towards obstetricians. Many midwifery websites discuss high Cesarean rates or “unnecessary” interventions of physicians. The website of the American College of Nurse-Midwives is very clear on “disruptions to a normal healthy birth” which include medications and Cesarean delivery.
The American Association of Nurse Practitioners (AANP) promoted themselves on social media with the slogan “brains of a doctor and heart of a nurse,” and with memes stating: “Be nice to nurses. We keep the doctors from accidentally killing you,” and “Behind every great doctor is an even greater nurse.”

Much of this centers on the shortage of physicians and the nursing profession's hope to fill that gap with nurse practitioners. But, while medical and nursing fields are overlapping, they are not truly competing. The average nurse practitioner has 1.5-3 years of training in a Masters program, or about 500-1000 clinical hours, after college. A family medicine physician, on the other hand, will work 6,000 clinical hours in medical school, which lasts four years, followed by a 3-year residency, averaging an additional 9,000-10,000 clinical hours. Those numbers would be even higher for specialists.

And the problem is really a complementary advantage than an antagonism: Medicine is regrettably more a science than a service and nursing thankfully more a service than a science.

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