Doctors are in increasingly short supply these days, so it's not uncommon for patients to spend more time with physician assistants (PAs) and nurse practitioners (NPs) than their actual MD. This trend has sparked controversy among physicians and patients alike. While so-called “mid-level providers” like NPs and PAs are undoubtedly essential for filling gaps in the healthcare system, there is some concern that these men and women are tasked with responsibilities that are beyond the scope of their training and expertise.
Angela Golden, DNP, immediate past president of the American Association of Nurse Practitioners, doesn’t see this as an issue. “There is a healthcare provider shortage all over the United States,” she points out. “Since 80 percent of nurse practitioners practice in primary care, we are an excellent source for healthcare.”
While this may be true for general medical care, others are concerned that doctors delegate too many specialized tasks to mid-level providers. NPs and PAs are trained in using and interpreting a wide range of diagnostic tools to diagnose and treat acute, episodic and chronic conditions, therefore it can be difficult to ascertain where their expertise begins and ends.
Understanding The Differences Between Healthcare Professionals
First, it's essential to understand what separates a mid-level provider from a full-blown physician. Just because a healthcare worker doesn't have “MD” or “DO” following their name doesn't mean they are not capable of offering quality care, according to Golden. NPs, for example, are typically required to attend a four-year nursing program, obtain a doctoral or master's degree, and go through a national certification process. A great deal of real world experience is gathered throughout this process, and they also undergo periodic peer reviews and participate in continuing education courses.
PAs have similar requirements. Specific duties vary by care setting and state laws, however typically physician assistants complete at least a masters level education and over 2,000 clinical practice hours in advance of certification. A certifying exam is necessary within six years of completion of the PA degree. Only after completion of the certification exam is a PA eligible for state licensure and allowed to practice care.
As a result, NPs and PAs can execute a diverse array of medical care tasks. They can order and conduct diagnostic tests and lab work, perform in-office procedures, prescribe medications, and diagnose and treat health conditions like high blood pressure, injuries, infections and diabetes. Depending on the regulations of the state in which they're practicing, mid-level providers either work under the direction of or in collaboration with a physician.
The fact that NPs and PAs spend more quality time with individual patients often facilitates candid communication. Thus, these providers can gain valuable insight into patients’ specific care needs. “We have years of experience working with patients one on one and developing critical listening skills,” says Margaret Dean, a geriatric NP and assistant professor of nursing with the Texas Tech School of Medicine. While their true strength lies in the realm of primary care, some NPs and PAs also pursue specialized training in areas such as gerontology and women's health.
However, there are definite differences between doctors and nurses. Kathryn Boling, MD, a primary care physician with Mercy Medical Center in Lutherville, Maryland, started out as an NP before becoming a doctor. “Physicians are better trained,” Boling admits, citing the extensive residency period that doctors are required to go through after their years of schooling and the fact that far more physicians undergo specialized training in a specific area of practice.
Quality Care is Key
As healthcare providers look for creative ways to meet the needs of an aging population, patients and caregivers will need to use common sense when it comes to deciding whether a care provider is safe and effective—regardless of his or her title. Older adults in particular are prone to putting doctors on a pedestal, but such deference can be detrimental to their care if they blindly trust an MD or won't take direction from an NP.
“Patients are smart,” says Boling. “They can usually tell if their provider—whether an NP or MD—is a good fit and cares about them. If they have an NP or PA that is attentive and takes good care of them, then they should trust that person.”
In the end, the quality of care a patient receives determines whether a healthcare provider is a good match. If a patient’s needs are too specialized or complex, any level of medical professional should be comfortable with asking for assistance or providing a referral to another provider who is more knowledgeable.