Classism in the Hospital-MD vs. RN

[paramedic-RN]

This is not at all meat to be a rant about doctors, I have a ton of respect for doctors and love the doctors I work with but my boyfriend made a recent observation about how hospitals play into the classist separation of nurses and doctors I thought it was an interesting point that I just wanted to share.

At my hospital all the ER nurses have to park in the garage then walk to the hospital but the ER physicians have premium spots right next to the ambulance bay. Why can’t they park in the garage with the rest of us?

Our “doctor’s lounge” is fully stocked with free snacks and a mini buffet all the time. There’s no “nurse lounge” just break rooms.

At many free standing ER’s and small ER’s there is a “sleeping room” for the doctors and I’m not talking about an “on call” room I’m talking about the doctors who are like on the clock working that shift. Why don’t nurses get to nap on night shift? Sure someone has to stay awake but the nurses could take turns napping.

Why are physicians formally addressed as Dr..(last name) but nurses aren’t formally addressed as Nurse (last name). Why is it blasphemy to call a physician by their first name but not a nurse by their first name?

All these little details add up and subconsciously play on the psychology of nurses and doctors so it’s not surprise when you hear a near who’s hesitant to page a physician because she doesn’t want to “bother” them with an order they forgot to put in! Or nurses that are scared to question physicians over an order.

Do you guys see any other examples of this in your hospital?

[NICU Guy, BSN, RN]

12 hours ago, paramedic-RN said:

Why are physicians formally addressed as Dr..(last name) but nurses aren’t formally addressed as Nurse (last name). Why is it blasphemy to call a physician by their first name but not a nurse by their first name?

On my unit, Drs. are commonly referred to by their first name. Most of the time when doctors call me they identify themselves by their first name. Nurses are referred to by their first name. I have never heard anyone referred to as Nurse XXX. Maybe the difference is that the doctors are on the unit 24/7.

[OUxPhys, BSN, RN]

As one poster pointed out the MDs bring in money whereas we are viewed as a large expense. Most of the doctors are cool with me calling them by their first names but I still call them Dr (old habit from being in the military). The resident room is stocked but a lot of it isn't utilized so they usually dont care if we go in and take some of their snacks.

They also have a real crappy schedule with being on-call and getting slammed with admissions. Id rather work my 12 and go home than get stuck doing admissions all night and have a fully stocked snack bar.

[kidzcare]

On 10/1/2019 at 12:14 PM, TriciaJ said:

In most hospitals MD = revenue; RN = expense. Most hospitals are run by bean-counters so most things (and people) are broken down into incoming beans and outgoing beans.

Real talk. This is a huge reason.

I think some of it may be rooted in sexism as well. Lingering effects of when only men could be doctors and only women could be nurses.

[JBMmom, MSN, NP]

As others have mentioned, revenue is generated by the doctors in a hospital. They can attract patients, and other providers, based on the presence of particular doctors or specialists. As nurses we are a cost to the hospital and while we impact things like patient satisfaction and Press Ganey scores, we are not individually revenue generators. Also, the number of nurses vs the number of doctors probably limits the parking perks, free food, etc. they can offer. If nurses had the closest parking spaces, there would be no spaces for anyone else!

As for respect, you give what you get. I have no problem addressing a doctor as "doctor", they put a whole lot of time and money into their education and they earned that title. Nurses may have worked hard for their educations as well, but it's not a degree title in the same way. No one is referred to as accountant Bob or hairstylist Jane. It's not a sign of disrespect, it's the way the majority of the world is. I'm also not defined by my job, so I wouldn't ever expect anyone to call me Nurse XXX. The role of doctors and nurses is obviously very different. As the direct care provider for patients, no, you're not going to sleep during a shift. Some doctors can, some can't. But at the end of my shift I'm also going to go home to my life. No one is going to call me for orders, I'm not going to have to do any billing, or notes, or anything else that goes along with the responsibility of being the doctor. I don't think it's anything classist, it's just the way things are.

[ClaraRedheart, BSN, RN]

I will call a doctor "Dr ____" Unless they expressly ask me to do otherwise. I've had patients that are doctors and I will refer to them by the doctor pronoun if they seem to prefer it. Most do. I had one guy say "You can call me Larry or Dr. Smith". I called him Dr. Smith. Fact is, they had 10 intense years to earn the title. Their work entails a LOT more responsibility than mine does. When they leave, they are often on call. I do NOT want to be a doctor and I respect the hell out of them. I've had patients ask me if I plan to go back to school to become a doctor. No. No, I don't. I enjoy having a life. I enjoy going home and forgetting about my day. Doctors have earned their sleeping room, salary, buffets and title.

[BSN-to-MSN, ADN, BSN, RN]

At my hospital there are "physicians" and "staff". And, if patient's satisfaction scores are down with MDs, nurses are expected to "manage up" docs more, MDs are not expected to do anything different. Nurses are more readily "replaceable". We do have some nice and respectful MDs though, no jerks, I will give them that.

[BSN-to-MSN, ADN, BSN, RN]

1 hour ago, ClaraRedheart said:

I've had patients that are doctors and I will refer to them by the doctor pronoun if they seem to prefer it. Most do.

Yes, they've earned it. When a doctor as a patient wants to be called a doctor, it is amusing to me. Do they want to do their own surgery, too? I remind myself that I will want to be called a nurse (my name here) next time I'm hospitalized, just for kicks. That would be a riot!

[Horseshoe, BSN, RN]

I've been out of the hospital setting a good while; still, I cannot imagine calling a doctor by his first name while at work.

As others have mentioned, it should be pretty obvious that doctors are valued more by the hospitals because they bring in revenue. The hospital doesn't want them to leave and request privileges elsewhere, so they give them perks to keep them happy.

I treat doctors with respect and expect the same. However, let's not be naive - in addition to the dollars they bring to the hospital, their education is far more advanced than the average nurse or ancillary staff member, and our society values and rewards that kind of time, effort, and achievement. With good reason. I don't worship someone with advanced education, but I do respect what it takes to get to that level.

I've noticed that a lot of nurses on AN display a strong disdain for advanced education. Most don't seem to have a clue what it takes to get to the doctorate level and beyond. I can only conclude that this represents an inner insecurity.

[rn1965, ADN]

I call the MD Dr._______ unless they ask me to call them by their first name. Years ago, I worked on an antepartum unit and all the physicians wanted to be addressed by their first names only. In the OR, they wanted Dr. until the pt was asleep, then it was first names.

I started as a CNA in 1980 and in a very catholic hospital. When a Dr. entered the unit, all nurses, etc. got up and gave them their spots. Also, they had private dining, completely stocked and private sleeping areas and we were not to disturb them.

Then again, we also lit their cigarettes for them and emptied their ashtrays......hahaha!

Times are changing, but, I feel if they went to school THAT long and take on that kind of responsibility, I will call them doctor.

[llg, PhD, RN]

One other point about parking. A lot of physicians don't spend their whole day at the same setting. They come and go to multiple settings. For example, they may check on hospitalized patients and then go to their clinic offices in another building -- on another campus. Giving them close parking saves them a lot of time and inconvenience, leading them to request good parking as part of their contract.

I work on a growing campus that is spread out, but short on shuttle buses, etc. My office is in one building while I frequently have to work in another that is on the far side of the campus. So I have a parking privileges in 2 different parking garages and can use the one most convenient for me. Physicians often have similar issues -- with multiple hospitals, private practice offices, various outpatient clinics, etc. Staff nurses usually work in the same building for their entire shift.

[nrsang97, BSN, RN]

I have had an attending in the neuro ICU request that I call him by his first name. If I called him Dr.Smith, he would say no, call me John. Most residents we also called by first name too. I don't have any issue with being called by my first name.

[KarenMS]

We call all the residents by their first names, and the nurses who have been around a while call the attendings by their first names too. I haven’t reached that level of comfort yet with the attendings, but also some of the nurses may have been around when the attendings were residents, and that’s the only way they’ve ever related.