Many people in the health care world would publicly claim that everyone is on the same team. In reality, however, there are definite hierarchies, which can be related to the money one earns, length of education, scope of practice, prestige and power. A surgeon, for example, is often described as “the captain of the ship,” making it sound as though everyone else is lower on the ladder, according to the University of Washington School of Medicine.
Nurses, Not Handmaidens
If you watch TV at all, it’s hard not to see nurses as the doctor’s handmaidens, according to an October 2010 article in “Nursing Times.” Nursing, however, is and has always been a separate profession, quite distinct from medicine. Nurses are responsible for determining issues such as required education, licensure and regulation of the profession. Although the two professions overlap and nurses do carry out care plans or physician’s orders, they are also required to question or refuse orders not in the patient’s best interest and have a different focus and special expertise.
Levels in Nursing
Within nursing, however, there are different levels of practice, determined by education and licensing. Nurse aides, for example, are unlicensed and limited in what they can do. They can only work under the supervision of a licensed nurse. LPNs have a year of formal education and can perform more complex tasks such as managing an intravenous line or inserting a urinary catheter. However, LPNs still cannot practice independently and must have RN or physician supervision. RNs have more education, more independence and a wider scope of practice, while advanced practice registered nurses perform physician functions.
Lowest of the Low
Within the world of the physician, hierarchies exist from the point at which an aspiring physician enters medical school, according to an April 2007 article in “The New York Times.” When formal training programs for doctors were first established in the late 19th century, senior physicians had the most knowledge, experience and power. Residents, who had recently graduated from medical school but did not yet have enough experience to enter private practice, were the next layer in the hierarchy. Medical students were at the bottom. The culture still persists in many training programs, according to “The New York Times.”
'Cause I'm a Woman
Gender may also be a factor in the physician hierarchy, according to a 2013 article in “Social Thought and Research.” Although women are numerous in some specialties, such as obstetrics and pediatrics, others such as surgery tend to be dominated by males. This may be partly because women sometimes choose medical specialties that are more family friendly and promote work-life balance. The study found, however, that some women reported harassment and sexual bias during medical school and residency, which may have affected their choice of specialty.
Although the hierarchy is informal and not often openly discussed, another type of physician hierarchy is related to specialization. Some of the hierarchy has to do with reimbursement for certain kinds of care. Invasive procedures and surgery, for example, offer higher reimbursements. As a result, physicians who can bring extra revenue into the hospital setting are often treated with a certain degree of favoritism by hospital administrators, according to the “WMA Medical Ethics Manual.” A hierarchy also exists within specialties, in which those who work in academic settings have more prestige than those in private or public practice.
- University of Washington School of Medicine: Ethics in Medicine
- Nursing Times: The Image of Nursing the Handmaiden
- U.S. Bureau of Labor Statistics: Nursing Aides, Orderlies and Assistants
- U.S. Bureau of Labor Statistics: Licensed Practical and Vocational Nurses
- U.S. Bureau of Labor Statistics: Registered Nurses
- The New York Times: In a Hospital Hierarchy, Speaking Up Is Hard to Do
- World Medical Association: WMA Medical Ethics Manual
- Social Thought and Research: Increasing Representation, Maintaining Hierarchy - An Assessment of Gender and Medical Specialization
Beth Greenwood is an RN and has been a writer since 2010. She specializes in medical and health topics, as well as career articles about health care professions. Greenwood holds an Associate of Science in nursing from Shasta College.