Strategies for Moving Away From Doctor Dominant to Nurse-doctor Team Models: Medical and Health Care Models in Transition

Doctors represent the ideal model for medical care; nurses represent the ideal model for nursing care. People everywhere around the world are familiar with the doctor-dominant medical model which functions as a doctor working in conjunction with registered nurses.

The transition from doctor-dominant medical models to nurse-doctor health care team models is gradually taking place, all around the world, in spite of the reality, that it is not an easy scenario for people anywhere to comprehend or accept.

The increasing, global shortage of doctors and nurses is resulting in transitions from doctor-dominant teams to nurse-doctor teams, as a plausible solution to help meet the growing demands for medical and health care by the rapidly expanding, global population.

"Aphorisms by Hippocrates” (400 BCE) as translated by Francis Adams, suggests, 

"Life is short, and art long; the crisis fleeting, experience perilous, and decision difficult. The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals cooperate.”

This short statement appears to depict the doctor-dominant model of physician in the western world, but not necessarily other parts of the world.

According to the freedictionary.com, the word physician depicts “a person licensed to practice medicine”, “a person who practices general medicine as distinct from surgery” or “a person who heals or exerts a healing influence”.

In other words, the word physician has broad implications in North America, but there are stipulations with respect to legal qualifications and licensing of those who practice medicine or are practitioners of medicine.

Note the gradual transitions of medical models from the title of doctor to physician, practitioner and nurse practitioner. There is another model, that of assistant doctor training to be a doctor.

The original Hippocratic model of the doctor-dominant model has undergone transition to the nurse-doctor team model, where a nurse who is working directly with a physician becomes a nurse practitioner. 

The doctor, physician and practitioner function independently, while the nurse practitioner works directly under the doctor, physician or another kind of practitioner, together as a team. In other words, while the nurse practitioner begins to take on some of the primary roles and responsibilities of a doctor, ultimately the responsibility still lies with the doctor, physician or the other practitioner with whom he or she works.

Nurse practitioners are more advanced practice registered nurses working with nursing models. On the other hand, a doctor’s assistant works directly with the doctor who has the authority and responsibility to oversee the medical care he or she provides.

Is there room for five different models in the realm of medicine and health care?

To respond to this, one must ask, is there still a need for medical and health care globally? Increasing the number of health care professionals, on any level, is potentially beneficial to the global community, even though the transition may be difficult for people to accept.

With respect to the role of doctor, each time there are new medical or health care models introduced, a doctor may be able to extend his or her medical horizons to a higher level of education or research, which in time will serve to benefit to the global community.

Progress in the medical world invariably demands that the medical process continues with or without the ultimate approval of the masses. Every level of medical education and health care is perilous to some degree, for anyone who is courageous enough to take the first step or climb higher.

Getting what Hippocrates calls the externals to cooperate may be the big problem. Training the attendants on whatever model is current is always the doctor's responsibility. Patients will benefit, as long as they cooperate with the doctor and his current models.