Dawn Zuidgeest-Craft is an incoming resident in family medicine in Michigan. This essay first appeared in STAT News.
Since I was 7, my goal has been to become a doctor. This year, at almost 73, my dream will finally come true. I will soon start my residency in family medicine in Michigan. My perspective on medical school and medicine is unique not only because I attended late in life but also because it came after more than 40 years as a nurse practitioner.
After I got my bachelor’s degree in nursing at Michigan State in 1980, the neonatal intensive care unit became my home. I took premedical classes in the evening. Then, a neonatal nurse practitioner program opened in Southern California, offering me a then-rare opportunity to practice in a medical role. I attended the program, graduated, and returned to Michigan in 1981.
At that time, nurses in Grand Rapids were not permitted to place an IV in a pediatric or neonatal patient. No nurse was responsible for leading the resuscitation and admission of a critically ill infant. No nurse was responsible for the procedures involved in this care, including intubation, chest tubes, umbilical central lines, and more.
The nurse practitioner program provided education in the pathophysiology of neonatal medicine and ample time to hone medical procedures necessary for management of the high-risk infant. But there was much more that the program failed to provide, such as advanced anatomy and genetics. I devoted my own time to filling the gaps in my basic science knowledge. The University of Florida College of Medicine offers a certificate program in medical anatomy and physiology, which provides the medical courses lacking in many master of science in nursing-nurse practitioner programs. In 2016, I completed that program, which gave me a strong foundation to proceed to medical school in 2022.
Why did I wait so long? Life. After I finished undergrad I wanted to apply to medical school and began my additional premed requirements. I married, had two children, and became a neonatal nurse practitioner. At 35, I divorced, took the Medical College Admission Test, and applied to medical school but was denied. At that time I met my second husband. We married and my youngest child was born when I was 49. At 50, I assumed my dreams of becoming a doctor were done.
Then, in 2020, an accident almost took my husband’s life. We talked about what we wanted to do with the life we had left. He wanted to travel and I wanted to go to medical school. So at 69 I applied to St. James School of Medicine in the Caribbean. My husband traveled the Caribbean while I studied, and we traveled together after I completed my medical degree.
I learned a lot in my four years in medical school about the difference between being a nurse practitioner and a physician. Now that I have traversed both paths, I can say that there’s a great deal of overlap between the roles, but both educational journeys are missing some important elements.
As a neonatal nurse who later became a nurse practitioner, I was a stronger physician. My years of bedside neonatal nursing gave me an education that my coursework simply couldn’t.
A pediatrician or neonatologist does not have that opportunity. They go through a longer and less focused path: four years of medical school, three years of pediatric residency, and two to three years of neonatal fellowship with a focus on research.
My two years of clinical coursework in medical school were interesting but not focused. Not unlike the clinicals in a bachelor of science in nursing program, it included adult critical care, emergency, surgery, internal medicine, pediatrics, obstetrics, and psychiatry. My electives were engaging, but if a student’s ultimate goal were to become a specialist, as mine was, these were simply time-consuming and did not improve my knowledge in my field of expertise.
Neonatal physicians don’t get the experience of bedside management of critically ill newborns, which would teach them how to assess patients who cannot speak for themselves. Not unlike a parent’s intuition that something is off, this clinical time teaches how to recognize those changes that indicate a medical emergency.
A prime example is feeding intolerance. The bedside nurse does not just see the amount a patient gets but also subtle changes in their response to that feeding. This enables the early recognition of possible necrotizing enterocolitis. Medical school and residency do not teach this. It is experiential. The current neonatologists depend on nurses to alert them to how a patient responds to treatment. But what if the neonatologist had that experience?
Our current health care educational paths make little sense. Medicine is no longer the general practice of 1940. Medical school curricula have essentially not changed since that time, yet the knowledge and evidence-based data have escalated to levels unimaginable when these curricula were developed.
I went to medical school at 69 to learn what I did not know. It enlightened me as to the need for contemporary health care-specific preparation. We need a reduction in duplication and a focus on today’s knowledge, especially with advanced technologies.
I start residency on July 1 and turn 73 on July 7. I hope to contribute to not just patient care but also to how we educate our providers.