The Difference Between Nurse Practitioners, Physician Assistants and Doctors


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.

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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..
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!
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. :)