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I’m Shirie Leng, an anesthesiologist.  I have worked in health care both as a nurse and as a doctor for 15 years.  The health care industry is just that, an industry.  As such it doesn’t have a whole lot of concern for the “customer”.  I write about the processes, redundancies, red-tape and pure pointlessness of much of medicine, so that you can make decisions and navigate for yourself. 

I’m also a mother with three young girls.  You might find some posts about them as well!

  1. Alopi permalink

    I love this blog! I’m a fourth year female medical student going into anesthesia. It’s good to see very honest opinions of doctors and particularly, an anesthesiologist! Thanks for the insight, I’ll be looking to these for inspiration as residency starts!

    • Jen permalink

      Just started reading your blog, I love it!
      I am a Registered Nurse currently finishing the NP masters course, working in primary care/chronic disease (Western Australia). Thanks heaps for your openness, insight and humour!!

      • Thanks for reading! I’m working on a book about medicine and advanced practice nursing, so stay tuned!

  2. Thank you for your brilliant blog! I’m only a medical student, but immensely interested in anaesthesiology (or anaesthetics as we say). Cheers!

  3. Sam Morris permalink

    Hi Shirie,
    My name is Sam Morris and I am working on an article on Freeman Allen as well. I find you interest and research fascinating. I would love to get in touch because I am working alongside my uncle who is an anesthesiologist at Children’s Hospital in Boston. Let me know if you would be interested in exchanging information.

    • No way! I didn’t know anyone knew about Freeman. Who is your uncle? I did 4 months at Boston Children’s during my anesthesia residency. I would love to talk about Freeman. I had started my research as an article but now I have about 50 pages…

  4. Nelya permalink

    Hey Shirie Leng! I just read your about section and you mentioned you had been a nurse and have become an anesthesiologist. I am currently a nurse, I have only been one for a year and I am trying to decide what to do with my career.I am considering become a CRNA or anesthesiologist. What has led you to become an anesthesiologist from a nurse?

    • Thanks for reading! The CRNA vs anesthesiologist decision is a big one and depends primarily on two things: Why do you want to pursue more training, and what is your long-term goal. I was a nurse who was very unhappy as a nurse. I went to med school because I wanted to be the one in discussions around the patient’s bed and the one writing the orders. I wanted the deeper, broader understanding. I thought I knew what I was getting into. 10 years and $200,000 later it’s clear I had no idea. If you want to be a doctor, be a doctor. If you really like science and feel a calling, be a doctor. Otherwise, go the CRNA route. It’s shorter, cheaper, you will be doing the same things an anesthesiologist does without all the responsibility and all the overnight and weekend call, and an experienced CRNA makes as much as $150,000/year. Good luck!

      • CA CRNA permalink

        ” It’s shorter, cheaper, you will be doing the same things an anesthesiologist does without all the responsibility and all the overnight and weekend call, and an experienced CRNA makes as much as $150,000/year. ” Just to be clear there are plenty of CRNA jobs where your statement does not apply. The nearest practicing anesthesiologist practices over an hour a way from our hospital and we take 7-8 24 hr call days a month including one weekend a month. We are also the only designated trauma center in the county so there is plenty of call back. Court law simply does not support your assertion that there is less responsibility. To be clear yes, there are plenty of CRNA jobs that meet the criteria you mentioned of no call weekends etc. but the same can be said of Anesthesiologists. Keep up the good work I do enjoy reading your blog.

      • I stand corrected. In my little corner of the world CRNAs don’t take call, but it is wrong for me to assume that is true everywhere. Thank you.

  5. Hi Sheri,

    I hope this finds you well, and in researching people leading the field for alarm bell fatigue I came across articles on what you are doing for patient engagement. My company, , is working to replace the call bell with software patients use to interact with their nursing staff and caregivers. I have included our “pitch” below, and if you would have any time to discuss what we are doing place let me know.

    The VerbalCare cloud collects and analyzes patient interactions providing valuable data metrics to improve meaningful use, patient engagement, patient satisfaction, care quality, efficiency, and safety initiatives. Using customizable picture-icons displayed on iPads, patients select from a variety of options to inform care staff of their exact needs prior to the nursing staff’s arrival. Our system dashboard analyzes interactions and allows administrators to track and manage care efficiency and quality so that hospitals and nursing homes operate more effectively. The current software aims to replace the call button, and we launched this in early November. We are also looking into other features like ordering food, uploading discharge information to help educate the patients, and ways to assist with rounding. Our first pilot was at Massachusetts General Hospital and we are welcoming Franciscan Hospital for Children as our first client.



    Julie Merritt
    Verbal Applications, Inc.
    Vice President of Sales and Marketing
    One Marina Park Drive
    Boston, MA 02210

    • Julie – Thanks for reading! What your company is doing sounds very interesting. Would like to know what MGH had to say!

  6. Hi Shirie,

    My name is Patrick and I am currently in my 3rd year of a BSN program at Indiana University. I am having a very tough time deciding between being a nurse and a physician, which is a struggle I’ve been dealing with since day 1 of my undergraduate career. I’m looking into post-bacc pre-med programs in case I do decide to go into medicine, but I’m wondering if you have any specific advice/insight on the issue due to your experience in both fields. Should I just go into advanced practice? Is being a doctor really all it’s cracked up to be? What motivation should I have that would warrant me going to medical school instead of going into advance practice nursing? Are there certain specialties that would make this decision easier one way or the other? Am I completely nuts for not being able to decide yet? Etc… Would love to hear from you!

    All the best,

    • Patrick-
      Oh my I don’t envy you your decision! So many people have asked me about this. I’ll give you a two-part answer. First, my own decision. I decided to go to med school because I was frustrated with nursing (I was NOT an NP). The thing about regular RN floor nursing is that you have a lot of responsibility and no power. People told me I should do ICU nursing or NP or nurse anesthetist but I was stubborn. At the time I thought I wanted to be the one making the decisions, being involved in the discussion around the bed on morning rounds, have that authority that you’re talking about. Having been a nurse I thought I knew what I was getting into. I had no idea.

      Part 2. I generally try to steer people away from medicine unless they are absolutely 100% couldnt-imagine-doing-anything-else, wanted-to-be-since-I-was-five kind of sure. This is not because the education and training take so long and are so hard. It’s because the hardness never ends. You sign up for medicine you sign up for a lifetime of call, nights, weekends, holidays, long hours. It never really gets any easier. You sign up for medicine you sign up for that lifestyle. Now, being an NP or CRNA can be hard but usually you are not buying into a lifestyle, but into a job. NPs can enjoy independence, diagnosis, treatment, definitely caring, and everything you talked about. Some NPs and CRNAs take call many work long hours, but your options for work/life balance are greater. A lot of what you would do as an NP and how respected you would be depends on where you chose to practice, and who with. A physician or physician group that values and honors their NPs is a great and rewarding place to work.

      Find out as much as you can about both. Shadow doctors and nurses, ask people what it’s like, be a CNA in different settings. You never know what it will be like for sure, but arm yourself with knowledge.

      Hope this helps. Good luck!
      Show message history

      • “The thing about regular RN floor nursing is that you have a lot of responsibility and no power.” This is one of my pet peeves. You’re correct, floor nurses have no positional authority. But with the right personality, communication skills, political knowledge, cultural conditioning, and confidence, the floor nurse can wield incredible power. The stories about the ‘old head nurse’ who didn’t take ___ from any doctor is actually true….I lived it. In my opinion, there are a few variables at play but they center mostly on nursing school candidates, nursing school curriculum, communication skills, socialization process, and hospital nurse execs. And the reason why critical care nurses have a reputation different from the ‘regular’ floor nurse, is that those with large personalities, exceptional communication skills, and an abundance of self confidence find that they can blossom in areas where critical thinking skills can mean life or death for the patient. Hospitals are cultural bastions of the old boys network and disruptions from ‘below’ are not acceptable. But when they start at the top and trickle down (nurse execs), the ‘floor nurse’ will flourish.

      • Lee Ann Hildahl permalink

        Dr. Leng,

        I appreciate that you are taking the time to share this information to the future generations of healthcare providers. As you have pointed out, medical school is just the beginning of a profession where “the hardness” never ends.
        I am a nurse anesthetist married to an OBGYN. I have experienced the difference between my life as an anesthetist and my husband’s life as a physician. You are correct when you say that medicine is a lifestyle. Consider time with family and friends, ability to travel, to move, constant telephone calls and nights without sleep, costs of medical practice ( office, equipment, employees, billing, government regulations, and malpractice insurance) and the debt that follows so many after years of study. And, the demands are only increasing as the “pay for quality” (often referred to as cost effective results) is replacing a system where payment for work performed and “time” spent with the patient no longer has the same value. As a physician, much more of your time will be spent documenting your experience with the patient and is not the “fun” part of medicine. Many physicians have to hire a scribe in order to spend quality time with the patient. The costs of practicing medicine are increasing but the pay is not!!
        Healthcare is changing fast and the increasing costs of care for an aging population will effect us for years to come. I have tried to point out some of the realities of medical practice. Despite the negatives, we enjoy our work. It really is a lifelong, hard-work, “lifestyle” commitment. Be ready for it.!!

  7. That really does help!! Thanks so much–it’s definitely a tough decision. I’ll keep weighing my options and getting exposure. Ohhh the career-crisis college kid struggle… 😛

  8. lovelyelly permalink

    Hi Shirie,
    I’m only in my 1st year of a BSN program but after working with so many doctors in my clinical setting, I’ve already got my sights set on becoming a physician. Your blogs posts are very inspirational, and I wanted to ask your opinion about motherhood and medicine. I’m 25 yrs old and would love to have children at some point but my husband doesn’t think it’s feasible right now or even after getting my MD. He is 30 and in DPT school currently (so our career choices are both very demanding and time isn’t really on our side in my opinion). My question is how did you manage your educational goals while simultaneously raising 3 children? Also how do you manage it now that you’re a successful physician? Do you recommend waiting until after medical school?
    Thanks so much for any help you can give. I love reading your blogs!


    • Elly – thanks for reading! First of all, time probably still is on your side. I had my first child at age 39, after all my training was done. Of course, that was probably cutting it a little too close, but at 25 you still have time. I will tell you that when I was 25 kids were the very last thing I wanted. It may be selfish, but med school and residency require so much focus on personal goals that it’s very difficult to deal with children, who are all about me, me, me! I waited until I had fulfilled my own goals, so I was ready to turn my attention to someone else’s needs. That’s actually really big, because children’s needs are limitless.
      If you can’t wait, or don’t want to wait, understand that you will need massive amounts of childcare. Move close to relatives if you can. Invest in the very best nanny you can afford, because daycare won’t cover the hours you’ll need. I have a friend who is a doctor, her husband is also, and they have two nannies and a mother-in-law. I myself had a nanny who worked 50 hours a week, but in anesthesia the schedule is better than most specialties. And I have a super helpful husband, also a must! If you’re worried that your kids won’t know you, they will. They’ll know you as a strong, hardworking woman. And they will benefit from that knowledge and respect you for it. If you’re worried that you’ll miss out on important milestones in their lives, you will.
      You can have kids and be a doctor, and thousands of women do, but you can’t “have it all”. Such a thing doesn’t exist. Please remember that.
      Good luck!

  9. johnbennett70 permalink

    Hi Shirley:

    Your blog is certainly refreshing. That is why I put it in the “Anesthesiology Blogs” in my website

    One thing that does distinguish you amongst most bloggers is that you respond to comments, which is great.

    We have started “Google Hangouts”, and have had a few with Ric Novak MD, an Anesthesiologist from Stanford, which have been, to me, super interesting, from “Anesthesia and Obamacare”, “The Twenty Five Most Interesting Developments In Anesthesia in 25 Years”, and one which some may consider a bit morbid, “Lethal Anesthesia”. In this humdiniger, Ric discusses the issue of Anesthesiologists view of being there during Executions by injection in the USA. California Anesthesiologist won’t do it, but some states still do.

    Check them out here:


    john bennett md

  10. “OK. So say you are 80 years old. You fall and break a couple of bones. One break is deemed non-operable, maybe a couple of vertebral fractures that don’t AFFECT your spinal cord.” Jeff Kaplan

  11. t’zor right – nice work

  12. Rachel T permalink

    Dr. Leng- I just came across your blog- thank you for your candid accounts- I would love to hear more on being an anesthesiologist – I am currently wrapping up 2nd yr of med school and I interested in ANES or IM- I also have a 1 yo at home- so appreciate insight from that side as well! Also very interested in any resources you have for me. Thank you.

    • Rachel – thanks for reading! Wow. Anes and IM are totally totally totally different. I started out categorical medicine. I thought I wanted to be a cardiologist. I really disliked IM – especially clinic. I felt like I was spinning my wheels, treating what people had done to themselves without seeing much in the way of results. I also spent most of my time ordering tests, following up on tests, and ordering stuff, which meant I didn’t do much actual touching of patients. And endless rounding… 😦

      BUT – I liked critical care. So I could have gone two ways: finished IM and done interventional pulmonary, or anesthesia. I couldn’t stand another minute of IM. In anesthesia you have one patient at a time and you can do almost everything yourself. You need a lab? You draw it and send it to the stat lab – it’s back and you an act on any abnormal value immediately. You don’t have to wait for others to carry out your orders. You can just do it yourself. Plus there’s no clinic, a major plus! It’s kind of pure critical care without all the chronic stuff.

      A word of warning about anesthesia, though. It can be terrifically boring. It’s sort of the same thing over and over, and if things go well, as they usually do, you do a lot of sitting around staring at monitors.

      My advice: do a lot of both while you’re in med school. I found that the tone and personality of the residents and how they made me feel had a lot of impact on whether I liked a specialty or not. Try not to let that happen. Watch what the residents and attendings do – what do they do the most, what do they do over and over? Do they seem generally happy or not? Would they recommend their specialty? How much paperwork is involved and how painful is it? Stuff like that. It’s easy to get caught up in the moment when everything is new. You want to know what it will be like when everything is routine.

      As for your child – get tons of good childcare, no matter which way you go!

  13. dcwang permalink

    Dr. Leng:
    I graduated with a degree in music performance and I’m transitioning into a career into health sciences. I’ve enjoyed your articles about nursing vs. medicine. Have you previously worked with students seeking a second degree in health sciences?

    Thank you

    • Hey, thanks for reading. Guess what? I have a degree in music performance too! Useful degree, no? There a lot of us musician-doctors and musician-nurses out there! I went to nursing school, actually, after Manhattan School of Music, and I definitely think my background in the arts set my application apart. I attended the non-nurse college graduate program at Yale, and got a master’s in 3 years. Then went to med school, but still had to do two full years of pre-med. It kind of depends where you got your undergraduate degree. If you went to a conservatory then before med school you’re looking at at least two years of math and science at a post-baccalaureate pre-med program like the one I went to at UConn. If you went to a more traditional college you might not need that long. I also know a girl who did some post-bac work to improve her grades before applying to med school. But an arts background does set your application apart, whatever you choose.

      • nursingapplicant permalink

        Thanks for your reply! having applied to both nursing and medical school, how was the process different for you? if you were to do it over again, would you have gone the NP/CRNA route? As a nurse, would it be easier to have a work/lifestyle balance than MD? It seems like many new grads are having trouble finding jobs… Do you think the nursing shortage will be true within 5 years?

      • Medical school applications are far more arduous. My nursing master’s I think asked for the GRE and transcripts. Med school requires MCATs, transcripts, proof of completion of pre-requisites, and maybe an essay. And it all has to go through the medical school application database. If I had to do it again I’d go NP/CRNA every time. But never worry about getting a job as a nurse. The RN jobs are cyclical. When I graduated I had to beg for a job, but 5 years later I was getting job offers in the mail. Health care cost controls are going to make advanced-practice nurses in greater demand and you will always be able to find something without nights and weekends if you want. Not so, medicine, with few exceptions.

  14. nursingapplicant permalink

    I also see that you specialized in violin performance! Same instrumental background! By chance who did you study with there?

  15. adetokunbohr permalink

    Well done.

  16. Katy_tink permalink

    Hi! I am a sophomore in college and I saw that you said you are a Doctor and a Nurse. How does that work and is it looked down upon sometimes?

    I’ve recently been thinking of majoring in nursing instead of going to medical school. And I honestly don’t know what I want to do, but I have to switch to nursing this year to stay on track.

    I was actually kind of wanting to be a nurse and a doctor, but I was advised not to do so and that it doesn’t look good to say that when applying to either nursing school or medical school.

    Your blog is really awesome and I enjoy getting a first hand view point, thanks!

    • Katy – thanks for reading! My advice is switch to nursing for now and do all the pre-med requirements as well. Do well on the pre-med classes, if you decide to go that route, and most medical schools won’t care what your degree is in. A background in nursing is never looked down upon. Plus, with a nursing degree you will always have a job. I worked as a nurse while going through pre-med.

  17. Bonnie permalink

    Curious how long you were able to work during pre-med? I am finishing nursing school now and will be starting pre-med classes. Not sure if I will go that route or not, but will take classes until I figure it out. I am 29 and a single mom of 2, so I’m not pie-in-the-sky here 🙂 I am not sure it can be done or should be done. I will always have to work. I have worked full-time in IT (a great career) for 8 years…was worried about being laid off so I started the nursing degree as a fall-back idea. Medicine is what I should have done in the first place, but I didn’t know that way back when 🙂

    • Bonnie – I worked two weekend shifts at my old nursing job while I did the pre-med requirements. Once in med school, that became impossible. Good luck!

  18. Hi, Shirie

    Caught your post today which, of course, brought me here. It’s inspiring and encouraging to see other female physician bloggers who articulate well the maelstrom of emotions and thoughts we all carry. Keep it up.

  19. Michael R. Wentzel permalink

    So…I am a 12-year veteran nurse turned 1st year medical student after dropping out of CRNA school. Was wondering if would could chat via email. I have some questions I would like to have your opinion on.


  20. Brittany permalink

    Hi, I am currently in an entry level nurse practitioner program one year in, and two years since graduating undergrad with a neuroscience degree. As I about to take my RN boards and start my DNP FNP program, all i can think is that I wanted more from my education. I face another three years of education, long hours, early mornings, weekend rotations. And I asked myself if I am already going through this why don’t go through medical school, yes its harder longer, but its what always wanted. ( The debt i will be from the FNP DNP will be around 280,000 and MD with my other loans, 350,000).

    When I was in college as was premed the whole process, but had doubts of getting into a program. I thought NP was the close best and I pursued it and got into a an excellent program. Now seeing in reality what NP, RN, CRNA, MDs do, I am still left with doubt. Some places accept the role of an NP well and others don’t. Many clinics I have worked with have MD/NP on the same playing field but I have not seen that in most hospitals. I am 25 single, no children, and no plans for until much much later, and I find myself pondering going to medical school. I have been studying for my mcat and lors and application ready to go but fearful that I will be thirty, in residency and wishing I was an NP.

    The difference between an internal medicine doc( I want to do internal or obgyn) and a FNP/CNM is not much… on paper. Yet when in the hospital NPs are doing the work of a doctor without the recognition or the same salary. What are you thoughts for someone that has been in the field for years and have been an RN and MD.

    From a midlife graduate crisis student.

    • Brittany – First of all, I was 25 when I started med school as well. I was a nurse working on a cardiac step-down floor, doing general medicine. My superiors told me I should try ICU nursing or PACU before throwing in the towel and going to med school but I didn’t listen. Now I wish I had become a CRNA – for me med school was just not worth it (I have @ $200,000 in student debt also). You haven’t said whether you like nursing, but if you do you might want to stay. However, saying of med school “it’s what I always wanted” tells me you should listen to that voice as well. Don’t do one thing because you don’t think you can do the other. An unhappy FNP does the field no good. Finally, in the majority of cases the working relationship between doctors and NPs in the same office is collegial and mutually satisfying. It is at the policy level that the fights go on.

  21. brittany permalink

    Thank you for your feedback, its greatly appreciated. To be very honest, and not to seem ungrateful, the experience or chance… I very much dislike nursing ( love the patients, but don’t enjoy much more). FNP’s role I do enjoy but not love, in regards to the actual duties that I have seen most NPs roles are in the hospital. The logical side of my tells m to stick with NP because it gives you the freedom of all the best worlds, in my personal life, family life, and sleep schedule. Yet, I feel that this is chance to go after what I want while I still have a shot and not in as much debt as I will be, if I change now.

    An additional question, is how do you feel about Caribbean schools, the top two? There quick entry, and high match rate and high USMILE average is very attractive to someone who is ready to switch. Ross university also has an accelerated path too. There cost of tuition is the same as my NP program. I am aware that to match in competitive residencies is low, only 25% of the class usually goes into surgery ect. But for someone who wants to do internal, it does not seem, on the surface, to be a barrier to entry.

    Thank you for your advice, and I hope to find my path and make it for the right decisions. Either as a happy and satisfied NP or an MD. Thank you for your advice and your blog. Giving your voice to support both pathway, is a great service for anyone in the allied medical field.


  22. Richard Griffith permalink

    I just retired from the practice of anesthesiology both private practice and academic practice, plus a decade as a medical director of an international medical device company. I have been working with residents in the last three years primarily trying to help them connect with patients in their pre-op visit. As a result I have created a 30 minute video that presents the things that I think have proven helpful. I would love your comments:

    Thank you very much.


    • Dr. Griffith this is fantastic! I have always thought that the most important part of our job is making a person feel comfortable putting their life in our hands. I the life-and-death stuff doesn’t, thankfully, actually happen very often, and the human connection is what sustains. I’ll post this up for everyone. Thank you so much!

  23. Erin permalink

    I’m trying to decide between going to an accelerated NP program (potentially getting a PhD in nursing down the line) or doing premed requirements and going to MD route. I am 31! I worry I’m too old to start Med school. I’m also worried about going to med school when I am around the age of wanting to start a family etc. Is it true that nursing is more flexible in terms of one’s schedule? It seems like all the doctors I work with are all over-worked (I work in public health research). But I am worried that being a nurse I will never have the same prestige or respect or ability to move to the top of my field as if I were a doctor. I know I am smart enough to do either but I am paralyzed by my indecision! THANK YOU for your great blog and any thoughts you can offer me!

    • Erin – I get many questions on this subject. First of all, 31 is not too old. It’s important to remember that med school and residency are part of life, not a state of suspended animation. Life goes on in and around training. It’s tricky, but it is done all the time. Nursing is absolutely more flexible, but flexible does you very little good in terms of happiness if you are a nurse thinking that you don’t have “prestige or respect”, as you put it. Nursing is not “medicine lite”. People who are happy nurses are nurses because they want to be in nursing. What most people don’t understand is that nursing and medicine are completely different fields. If you go over to KevinMD and put in my name you’ll find a post I did on the choice between medicine and nursing that gives a nice little summary of the philosophical differences. Then do what you want to do, not what others think you should do.

      • Erin permalink

        Thank you Shirie for your thoughtful response!

  24. Sam permalink

    Currently a senior med student debating EM vs anesthesia. I like the procedural aspects of anesthesia as well as the application of physiology and pharm. I am concerned that the role of the anesthesiologist in the near future will change as more crnas are directly administering anesthesia themselves. Appreciate any thoughts!

    • Sam – thanks for reading! If you like procedures, either EM or anesthesia will get you there. Anesthesia is more pure critical care; in EM you do alot of primary care as well. As for the future of anesthesia – there will always be anesthesiologists, don’t you worry. The ASA is constantly pushing back against expanded roles for CRNAs (whether you agree with them or not) and after Joan River’s death, the importance of a trained anesthesiologist is more apparent to the general public. Good luck!

  25. musicmajor_89 permalink

    Hi Dr. Leng, I’ve previously posted here, I was a music major. As I’ve recently been accepted to nursing school, I read about how saturated big cities are with new grads. When do you think the job outlook will be better? I am considering accepting MGH Institute’s offer to their ABSN program. Do you have any thoughts on the program? Thanks!

    • Nursing jobs are kind of cyclical. When I graduated from nursing school in 1995 I had to beg for a job. 10 years later they were banging down my door. The outlook for nursing is very very good. I wouldn’t worry about that at all. I don’t know anything about the MGH program, but you can’t go wrong training in a big-city hospital.

  26. Interesting blogs well-written and informative. Unfortunately, too optimistic about the healthcare profession!

    • Dr. Cohen – Thanks for reading! I have always considered myself a pessimist with high expectations. Great for writing but not so good for personal sanity.

  27. Shirie,

    I am a fan. And when you wrote on Michael Davidson, I was moved. I am the executive director of The Center for Peer Review Justice where we consult and defend physicians and surgeons against the crime of physician peer review fraud, or “Sham Peer Review”. Under the Health Care Quality Improvement Act of 1986 and thousands of case law, the physician does not have substantive or factual due process ” due process” rights, only procedural due process or a right to a hearing in front of the same gang who prosecuted the doctor. Moreover, they have immunity under the law. It’s illogical, but it is the Federal Law. Why this law came to be is a story that I have written about.

    I would like to invite you to give an informal presentation on the topics you have written on in a webinar format as I suspect you have much to say. Thank you.

    Richard Willner

  28. Stella H permalink

    Dear Dr. Leng, I am not an MD. I am a mental health professional who worked for many years at McLean. Your words in this blog ring true for so many of us who have chosen the mission of healing as our life’s work. Thank you for your truth. Thank you for your love. And thank you for your work. With Warmth. SH

  29. Lee Ann Hildahl permalink

    I’m commenting about US IMG students. If these students pass their courses and all of the Step exams, etc., why should they be discriminated against when it comes to residency placement? These students have proven they are committed and have made great sacrifices both financially and personally. They take the same tests as the students educated in American medical schools to prove they have the required knowledge to proceed to residency training. They understand the culture and speak the language. This is their country and they want to practice here. More FMG are admitted to US residencies than US IMG and it does not appear
    to be based on test scores or ability. I see a real prejudice here.

  30. anonymous1989 permalink

    I’ll be entering an accelerated BSN program as a second degree student. Since nursing was a second degree for you, what advice would you have for being a successful second degree nursing student? How was the transition from one field to another?

    • Hi, thanks for reading! Biggest piece of advice: make sure you’re going into nursing because you love nursing. If you do that, the transition is easy. In fact, being a nurse with a background in other fields is incredibly useful. A larger knowledge of the world and of humanity can only help you successfully care for patients.

      The other thing I would say is, study hard, but pay attention to how you feel about the clinical work. That’s the stuff you’re going to be doing every day. If you don’t like clinical, you won’t like nursing.

  31. Danielle permalink

    Hi Shirie,

    Thank you so much for taking the time to respond to these questions! I am in a similar situation as some of the above posters, but was hoping to get your input.

    I am supposed to start an accelerated second-degree BSN/MSN program in two weeks, at the age of 27. I love the idea of having flexibility all along my career path, and the academics and structure of these programs seem so manageable to me. However, I have a strong desire to know the ins-and-outs of medicine and understand the pathophysiology/pharmacology at least as well as anyone else in my field. When I speak to physicians, they say that the NP’s and PA’s never quite reach the same level of understanding as the physicians. For me, this gives me great pause. I envision myself feeling defeated if I can never quite reach the pinnacle of a career path ten years from now, with a ceiling on my learning, understanding, and scope of practice. Simply having a good salary and stability may not be enough for me.

    Do you have advice for me? The ease of already being admitted into a program is fantastic, but I have spent the week researching how to take post-bacc classes starting this summer in a last-ditch effort to go the medical route. I want to enjoy my life, but fear being professionally unfulfilled in ten years if I do not make large sacrifices right now.

    Thank you for any insight at all!!!

    • Danielle – Thanks for your questions. The choice between medicine and nursing is one that people ask me about all the time. First of all, I don’t know what your first degree was in and I don’t know your motivations for seeking a nursing degree, so I’m going to assume that you have done due diligence in deciding that the health care field is indeed the right fit for you. Given that, let me emphasize that nursing is not “medicine lite”. Nursing and medicine are quite different. The happiest doctors and NPs are the ones who are invested in the path they’ve chosen and are not bothered by questions about who “knows more”. Physicians will always say that nurses don’t have the same level of understanding, and NPs will always say that they do, but most of the time those comments are based on bias or job security or lack of self-confidence. Don’t let other people’s opinions influence your decision. It is a personal one.

      Now, doctors do “know more” in the educational sense, it is true. They go to school for a long time and train for a long time. They have more medical knowledge than anyone else. That’s what med school is for. If it is pure medical knowledge you want, that’s the route you have to take. No shortcuts. If you want the buck to stop with you, a highly over-rated situation, go for it. However, medical knowledge and medical practice are very different things. It’s nice to have all the information but you’ll still be unhappy if the work you do every day as a doctor doesn’t interest you.

      NPs have all the medical knowledge they need to do the work they do. Reaching the pinnacle of a career has much less to do with medical knowledge and much more to do with enthusiasm for the work and love of the field. Happy NPs choose nursing and own it. Whatever you do, own it and don’t worry about who knows more.

  32. Patricia permalink

    I am a new, but now committed, reader of your blog. I love your good sense, your humor, and your ability to recognize and describe the irony and ridiculousness that is the practice of medicine.

    Many people have asked you about the decision of medicine v. nursing and your answers are spot on. But I thought I would add one more thought. The daughter of a good friend of mine (who is a nurse) was applying to colleges and pondering her future. For just a moment, the daughter considered medicine. My wise friend gave her daughter this piece of advice:

    “DON’T be a doctor. Be a vet. The patients are nicer and you are more likely to get paid and less likely to get bitten!”

    (The daughter went on to major in Eng Lit, spend her junior year in Scotland, loved it, stayed, finished up her masters there, met a fellow student from Germany, married, and they are living in London. Ah, life.) Tricia

  33. Patricia permalink

    At the risk of being truly annoying, I am adding one more comment about the difference between doctors and nurses. A doctor can name all of the kinins, leukotrienes, mediators and activators, and the entire pathogenesis of DIC in sepsis and septic shock; an experienced critical care nurse can recognize it at 30 feet. That is how medicine and nursing are complementary. Tricia

  34. I’m enjoying your blogs very much. Do you ever do public speaking to groups? I have some physicians who might like to hear from you. Laura

  35. Barbara Froehling permalink

    Greetings Shirie,
    My husband just showed me your ‘Patients are not Customers’ post on I read your bio. Our third daughter, Nadia, is an ICU RN that is currently in her 4th week of medical school. I enjoyed your candid description of why you chose to pursue an MD education. It sounded SO much like Nadia I was chuckling. Then your admission of having no idea what you were getting into had me laughing! Excuse me for looking on your Facebook page, but I see that you play violin very well. My oldest daughter, Natasha is a PT and lives in Acton, MA. She plays violin and viola and teaches her two nieces violin. Were you a Suzuki student? My husband is an Orthopaedic surgeon and I met him when I was a recovery room nurse. We have 4 children and they make a string quartet. Our youngest son is a third year medical student. Our second daughter, who deems herself the only offspring with imagination, is in the business world. Thanks for taking time out of your busy life to blog!!

  36. Hi Shirie,
    My name is Emma Morales and I am currently a high school senior. I am really interested in the medical field and I am thinking about pursuing anesthesiology as my future career. I am currently in an anatomy and physiology class and was given the assignment of interviewing someone whose career focuses on anatomy and physiology. I would love it if you would be willing to do the interview. I’ve been searching all over the internet for an anesthesiologist and came across your blog. I came across a lot of male bloggers but I really wanted to interview a female anesthesiologist. The interview consist of your personal experience, general information, and just your insight about your job. I hope you will accept the offer but I also understand if you wont. Regardless, thank you for taking your time to read my comment and I hope to hear from you soon.
    By the way, I really love your blog! I can’t wait to read more of your future post!

    • Of course! I would be glad to speak with you.

      • Thank you so much Shirie! Is there any form of media that you would prefer to conduct this interview? I can do e-mail, phone call, or even video chat. Also, is there any day that would be the most convenient for you? I’d appreciate it if you would reply to my email, Once again, thank you Shirie and I hope to hear from you soon.

  37. Thank you so much Shirie! Is there any form of media that you would prefer to conduct this interview? I can do e-mail, phone call, or even video chat. Also, is there any day that would be the most convenient for you? I’d appreciate it if you would reply to my email, Once again, thank you Shirie and I hope to hear from you soon.

  38. Science Student permalink

    Hey Dr. Leng! Pleased to find your website. Could you elaborate on why you decided to go med school after finishing the nursing degree? Was there something you found you didn’t like in nursing or thought being a doctor was more suited to you? Or something you learnt? I’m from the UK so I imagine there may or may not be differences in what nurses and doctors can do, but I’m interested to hear your story.

    Thanks 🙂

    • Wow. You asked me this question a long time ago and I have been very slow to respond. My apologies.
      My response is complicated, as these decisions are. Nursing, to me, had one major problem: a lot of responsibility and very little power. By power I mean the ability to get things done that you know need to be done. Nurses, at least regular medical-surgical nurses in US hospitals, have to obtain physician consent for most interventions, for example. Now, people who love nursing don’t feel that this is a problem. They feel empowered by their training and close physical contact with their patients, and feel that their relationship with doctors is collaborative.
      I, for better or worse, thought I wanted to be the one in charge. What I didn’t realize is that while doctors have medical knowledge (that’s what medical school is for), nurses (who have medical knowledge also, to a lesser degree) actually know how to care for individual people on an intimate and ongoing basis. Nursing and medicine are actually very different fields and not interchangeable. The choice is really this: Do you want to be an expert in medicine or do you want to be an expert in taking care of people.

      • CheshireCat permalink

        Hi Dr. Leng,

        I found your piece on KevinMD on nurse practitioners. I find you very insightful, encouraging, and not to mention incredibly intelligent, so in short, I apologize but I will most likely have other questions for you soon!

        Anyway would you say that this distinction you highlighted — “expert in medicine vs expert in taking care of people” — gets blurred when you factor in nurse practitioners? Theoretically, shouldn’t they be an expert at both, perhaps a bit more heavily on the “taking care” aspect but somewhat on par with primary care docs for the medicine bit?

        Also, I know in some states NP’s are allowed to stand alone, independently of doctor oversight. What do you think about having two different groups of people doing the same thing? I feel like it’s a bit overcomplicated, and could lend forth towards unnecessary competition. I chalk this up towards my own limited understanding but I’m also confused how these two can effectively be the same when the training and education is different? And do you think that possibly in the future we will see a phasing out of primary care/family med docs who are replaced by more abundant and cost-efficient NP’s and PA’s?

        I apologize for all the questions (please take your time in responding), and thanks in advance for any response!

  39. Alice Cave permalink

    Thanks for your thoughts! Appreciate your insider POV. Helps those of us trying to figure this mess out.

  40. Hi Dr. Leng, I am a reporter for Frontline Medical News. We are a national publication for physicians. I ran across your blog posts here and on KevinMD and I think you would make an excellent source for a news article we are working on. Is there a good way to reach you by email or phone? I could not find a contact for you on the website. My email address is My LinkedIn is

    Thanks, Alicia Gallegos, Frontline Medical News

  41. anonymous permalink

    Hi Dr. Leng,

    You mentioned that if you had to do it over again, you would become an NP or a CRNA. Who SHOULD go to medical school versus becoming an NP/PA? Would you regret not having more medical knowledge if you went the NP route?


    • Remember that when I made the decision to go to medical school, I had no idea I was going to end up practicing anesthesia. I thought I wanted to be a cardiologist! The people who go to medical school should go because they want to be doctors. Period.

  42. anonymous101216 permalink

    Hi Dr. Leng,

    Do you feel it was worth it going back to medical school for the knowledge vs. the NP/CRNA route, since the role of NP/CRNA seems to be closer to that of a physician?

    • Hi and thanks for reading! I personally do not feel, in retrospect, that going back to medical school was worth it. However, at the time I made my decision to go to medical school practicing anesthesia had not occurred to me. I was going back for the knowledge at that point.

  43. anonymous permalink

    Hi Dr. Leng,

    I am a recent Biology graduate working at Boston Children’s Hospital, also conflicted between nursing and medicine for a variety of reasons. I have read many of your responses to other comments giving advice, which is helpful. After realizing that you are local, I was wondering if you would be willing to chat with me to answer some of my specific questions? Even via phone.

    Thank you very much for your time.

  44. Flying Squirrel permalink

    Hi Dr. Leng, I was wondering if you could give me some guidance. I am a new BSN grad. I work in a small PICU. Halfway through college I started thinking that I wanted to know more physiology and understand everything at a deeper level and be able to diagnose and treat, so I took pre-med courses. Now I am applying and interviewing at med schools. My concern is that while I long for more knowledge and ability to make a difference, I really enjoy the close patient relationship and hands-on skills. I enjoy my job now, but I do want to know more. I have thought about NP, or maybe flight nurse or another ICU RN job. Assuming that scholarship/fin aid work out, in your view, is there room for me to find this fulfillment in medicine? I would love to hear your thoughts. -FS

    • Thanks for reading! First of all, you have all the knowledge you need right now to “make a difference”, so don’t worry about that. ICU nursing is a great field. You tend to have good collaborative relationships with doctors and do a lot of hands-on and work with families. I’m in awe of how much my ICU nurse friends know about physiology. If you enjoy nursing I’d stick with it. Becoming an NP is certainly an option but be aware you’d most likely be entering a more primary care environment. If you like the ICU I would highly recommend nurse anesthetist school. Lots of physiology, lots of patient contact. Stay tuned – my book on this subject is coming out hopefully later this month!

  45. Sarah cox permalink

    Hey Shirie-
    thank you so much for taking the time to write about your experiences! I looked over the comments and didn’t see much on the physician assistant path… just curious if this was ever a consideration for you and reasons for not choosing it . I heard it is taught more on the medical model and similar roles as a np.

    Thank you

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