Of greatest importance are the quality of care outcomes. As a doctor with a specialty in health outcomes and a primary focus on keeping seniors safe and happy, I would be remiss to not clarify that the statement, "physicians are better trained", is a relative term. The reality is, physicians are trained differently. There is no evidence to suggest one is superior to the other in terms of patient outcomes, safety and quality of care provided. Over 100 research studies, comparing the care of physicians and NPs, supports the fact that NPs provide, as good or better, care than physicians.

The article on NP, PA and MD or DO is right on target. My wife sees both and the special ones listen - I meant listen to us as we talk so they understand the needs - we see our spouses daily or take ourselves seriously most of the time. I am retired, but now as an RN who also has lots of experience and if the attending person doesn't listen to me as well, then they are NOT a good fit. One MD told me to do something that I had just read in an article by Mayo Clinic about a medication which was absolutely NOT indicated and I kindly told him so and he wrote me a letter telling me he could not take care of us. Change of caregiver was the immediate answer and telling others to NOT go to this MD. We are now being cared for as needed. They will listen if you treat them as they should be, but remember they also don't know everything. They don't walk on water nor are they GOD Who is the Great Physician.

I had bad experiences with both with my mother. The PA she was seeing wrote off her difficulty with breathing to COPD, when her shortness of breath was caused by congestive heart failure and an accumulation of fluid around her lungs. She never ordered am xray which would have diagnosed that. She also wrote off her auditory hallucinations (which were brand new) to dementia when she had a urinary tract infection. On the other had I took her her to one doctor who did a physical without actually touching her or listening to her heart. Both were terrible.

Why did the article not discuss the background, education and experience of Physician Assistants (PA)?

I find it hard to accept a NP when I am expected to pay the same price for seeing her as my Doctor. If the Doctors office is going to push us off on someone who is not as well trained as themselves then we should pay accordingly.

A couple of years ago I decided to have surgery to repair an iguinal hernia. Of course I needed to have a primary caregiver to diagnose it. The MD assigned through my insurance was out of the country the day of my appointment. Instead, an NP was filling in. Being 58, and never having a complete physical, I received a blood screen, and physical exam, which included a prostate exam by the NP. She also diagnosed the hernia, and refered me to a surgeon. Her being an attractive female may have been a problem when I was younger, but fortunately, everything was very professional/clinical, and nothing embarrasing happened.

My Primary Dr. just left her practice. Not wanting a man Dr., the only woman physician in that group is a Nurse Practitioner. I want the same medical care I had with my former Dr. I am not sure what to do. Any comments will be very helpful. Thank You.

I do not agree with patient's being passed on to NP's . I had a lumbar fusion one year ago. I have not seen this neurosurgeon since the day of the surgery. I continue to deal with residual pain and lacking a resolve for recovery. I see it as cost saving for large clinics

I concur with the response from Veronica91. I use a NP as my primary after so may primary MD's kept dropping my insurance company. MY NP is excellent and very thorough. Not only that, because I come from a family of varied heath care providers, I am quite informed in a lot of areas. Nothing is more offensive than when I go to a doctor and they want to talk to me like I am stupid or brush off minor health issues I am experiencing. I have experienced that both in hospital ER's in 2 different states and in doctor's offices. I do wellness visits with my NP because she is so thorough, friendly and patient. She is not afraid to inform, advise, educate or refer out. She does not think it ends with her. She will check anything she recommends with the physician before I leave the office. So who needs him if she can get a question for me answered faster than I can? In addition, two of my God-Sisters are an NP and a PA and another one is a Chemist at a major hospital in NYC. They are the best at what they do and often received warm cards of appreciation for their care. Yes, a doctor has way more training, but not enough in genuine patient care and that is where the healing process actually begins. Until I need a surgeon and a top-notch anesthesiologist (because on told me his job is not to put me to sleep but to make sure I wake up), I'll take a really good PA any day. I do however, really like my kid's pediatrician so he can stay. :)

I personally think the visiting NP for my homebound mom is fantastic and much more attentive than any MD we have seen in some time. If anything arises that is beyond her scope then so be it but she is knowledgeable, compassionate & wonderful!

Well, as mentioned by Advocare Nurse "many of the MD's...have no interest in the geriatric population", but sure they have interest in billing Medicare. In more than 2 years I have never met my husband's "doctor", only by name in the Medicare Summary Notice. The "dirty work" belongs to the NP...not fair, or should I say illegal to be billing Medicare for the care of a patient that most probably she has never met.

The most significant difference I've noticed between a Nurse Practitioner, a Physician's Assistant and an MD (for routine care) is that only one is pointed toward the doorway with his/her hand on the doorknob.

As a Geriatric Nurse Practitioner I agree with both sides of this article. Many of the MD's I have worked with over the past 23 years have no interest in seeing a geriatric population and are more than happy to have their patients followed by a midlevel provider (NP or PA). As the population of NP's and PA's has increased many are used to fill the gap of primary care physicians. I stick to what my training and background prepared me for... the treatment of common routine occurring medical problems in a focused population and refer things outside my scope of practice to my physician or specialist. If you prefer to be seen by a Physician that is your prerogative. Many patients and families are quite happy with the Holistic approach an Advanced Practice Nurse offers. Nurse Practitioners are Registered Nurses who work under their own license and in some states must have a collaborating physician while Physicians Assistance work under the Physicians license and do not have independent practice authority..

Well, we have just had an issue with the PA and medical staff not taking care of business - very unorganized. I consider the doctor at fault for not supervising his staff. I said' this does not reflect well on you, as YOUR name is on the practice.'
My father said that if he could not actually talk to his doctor more than once every two months, it was time to change, so we will.

The article is informative and well written but I absolutely agree with Pam when it comes to care for my myself or family.
PAs and NPs work under the supervision of a physician but extremely few MDs know what those under them are doing and the quality of their work.
Like everywhere else there are good and bad in all levels of care but when you walk in off the street you have no idea who will see you in the ER. I once went with really dangerously high blood pressure and I mean over 200. I discovered it was high by accident on a routine check and continued to monitor it every half hours which is good practice if not more frequently. They did give me something to lower it (down to 179) and sent me home with the diagnosis of high blood pressure due to over monitoring and advised me to put away my machine. All this with a known diagnosis of hypertension and valvular heart disease. The MD was Iraqi and the closest he came to examining me was to shake my hand. We beat feet out of there.
Experience is everything. I knew one new BSN graduate who within a year of graduation was invited to return to school to train as a NP she was obviously very smart but sadly lacking in hands on experience.
Then there are the MDs and sometimes I really wonder if they even went to medical school.
Do your research people protect yourselves and your loved ones get a second or even third opinion and decide what is right for you and if it is in your best interests or if the MD is putting notches on his resume before you sign that consent form.Mid level practitioners are essential (and cheaper) because there are not enough MDs BUT it costs the patient the same whoever they consult. I do speak a a RN married to an MD

As the Guardian for my sister, I insist that her care be with MD's and she has only doctors who actually see her in person. Same for myself, same for my husband. Unfortunately it is a lost art.

Very well-written article. It is also very helpful in figuring out the differences between nurse practitioners and physician assistants. Thanks for clearing it up. Hopefully, it has helped more people than just me! Thanks again.