Introduction

There is a certain amount of hostility between nurses and doctors. Nurses often resent the perceived role of handmaiden; doctors frequently deplore the inadequacies of their "assistants." There are uneasy boundaries between them--of responsibility, of expectation, of rank. MD/RN: Nurses Who Become Doctors is about the women and men who cross those boundaries.

More than two dozen nurses shared their stories of becoming doctors for this book. Each had a different set of personal and professional reasons for taking this very large step. Their decisions, however, inevitably involved one or a combination of three factors: They wanted the knowledge, or they wanted the control, or they wanted the status, of a physician.

Their stories as women (all but two are women) in medicine are timely. Their struggles to balance family and career are often both informative and cautionary. They talk about the antagonisms between nurses and doctors, they talk about where both nurses and doctors have gone wrong. They talk about competition, and ethics, and burn-out, and self-esteem. Issues concerning universal coverage, the cost of health care and the treatment of patients are all raised. The physician/nurses' views reflect their dual experiences. With remarkable candor, they tell what it was like to be a nurse, and what it's like to be a doctor. Perhaps no other group of physicians could be so honest.

It's not easy to become a doctor. You have to do well in your premed classes in college, extremely well. In medical school, you spend the first two years learning almost impossible amounts of book material, only to be treated as unpaid labor during your third and fourth years, while you learn even more on the hospital floors. When you have your medical degree, you can't practice medicine. You have to do at least a year's internship, and few physicians stop before completing two to six more years of residency in a specialty, medical or surgical. This is a time when you are driven almost beyond endurance by lack of sleep, the burdens of life and death responsibility, the need to acquire the knowledge and experience that will prepare you for a place in the medical community.

But this book deals with those who became nurses before they became doctors. That means they trained anywhere from two to four years to get their RN degree, and then they worked as nurses for varying lengths of time. It's hard work, often both physically and emotionally exhausting. When hese RNs decided to become doctors, they had to start pretty much at the beginning again--taking those premed classes other medical students took in college. It took most of them at least two years to get the prerequisites for medical school, and most were working as nurses at the time.Then there was the struggle to get into medical school itself, which was not always a welcoming environment for nurses.

Are these special people? You bet they are. They have the warm, responsive attributes of the best nurses, blended with the in-depth knowledge (and often sharper edges) of seasoned physicians. In the health care field, nurses are considered to be the ones who do the caring, physicians to do the curing. Here, in one person, both these elements are combined. It's a unique--and powerful--combination.

Many of the MD/RNs were interested in public health. Some had health care experience in foreign countries. Several came from families where a father or mother was a doctor or a nurse, but more commented on their roots in the working class. A disproportionate number of these nurse/doctors have gone into psychiatry and family practice. Why? Not only their personalities, but also their experiences in nursing, have a great deal to do with what field they have chosen.

Each participant tells her or his own story. You will hear one woman's edge, another's humor, a third's solid practicality. These people are bright and funny and tough and thoughtful and caring. Several of the MD/RNs are quite candid that "having a life" isn't something most physicians have learned to do. You'll discover how each one's situation dictated certain elements of her choice of specialty and lifestyle. For comparison, in the Pediatrics section, there are two nurses who haven't become doctors, and a doctor who was never a nurse.

MD/RN: Nurses Who Become Doctors has been divided into two parts, In Training and In Practice, which establish where these MD/RNs are in relation to their new careers. Those who are in training are still in a milieu where they can feel abused and exhausted. In time the intensity of that experience will fade, so its immediacy in their minds is important. And these are the women who were most recently nurses, who remember the nusing experience most vividly.

On the other hand, they don't have the length of experience some in the second half of the book do. They are still restricted in many ways, being guided by the training system. Sometimes you can hear that strain in their voices, and the wish to be done with this part of the process, to be getting on with their lives and their careers.

Those who have been practicing have their own stories to tell--from the seventy-year-old retired OB/GYN to the thirty-four-year-old director of a dermatologic laser surgery institute, from the divorced mother of three with a rural practice in Georgia to the academic pathologist who, with the proper encouragement, might have been a biochemist. Some talk about what it's like to be a woman in medicine, and others about being a woman doctor with young children: the issues that every working woman faces are multiplied by the demands of medicine.

Women who have only trained in medicine might not be as willing to speak of the problems with our medical system as these former nurses are. (Communication is one of the skills stressed far more in nursing than in medical education.) The MD/RNs have divided loyalties, and their vision is clearer for encompassing two different perspectives. Several times the opinion is expressed that the ultimate worry for physicians is not patient outcome or satisfaction, but fear of malpractice. This may be the kind of distortion which leads to unconscionable practices like outpatient mastectomies--if the patient isn't likely to die, and the doctor isn't going to be sued, why spend the money to keep her in the hospital?

These nurse/doctors come from all over the United States and represent a wide variety of specialties. Some have requested anonymity to preserve their privacy and/or to give them the freedom to divulge politically inexpedient information. Narratives will be added to this web site as they become available.

The author of MD/RN: Nurses Who Become Doctors is Neff Rotter, who may be reached via the "Contact Us" button on the opening page of this site. Neff writes fiction under her maiden name, Elizabeth Neff Walker. Her most recent novels have dealt with the relationships of women and men in the medical field. If medical fiction interests you, you may wish to find out more about her Fielding Medical Center Quartet (above).

(Those items in the Table of Contents which are underlined and in color will link you to completed narratives.)

This "cyberspace book" is dedicated to the memory of the remarkable Dr. Bob Walter, without whose assistance in getting started it could not have been undertaken. My thanks also to The Journal of the American Medical Women's Association for inserting an announcement of my project in their November, 1993 issue. To all the nurse/doctors and others who participated and assisted along the way, my most sincere gratitude.

For the sake of privacy, each of the participants in this cyberspace book has been given a pseudonym (or initials) to identify her or him. They are all, in fact, real individuals and not combinations of people, though some details may have been changed to preserve their anonymity. Their stories cannot be used by anyone without their permission.