When you say you’re “going to the doctor”, does that mean you’re seeing a doctor? Does it matter?

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There used to be a time in medicine when you would call a clinic and ask for an appointment for a cough and you would be given an appointment with Dr. _____ and then given a choice of times. Nowadays, when you call a clinic for an appointment for a cough, not only are you given a choice of times, but you are also given a choice of providers– doctor, nurse practitioner, physician assistant.

Why did we start seeing more of these advanced healthcare degrees in clinical and hospital settings? The short and oversimplified answer is this: an increasing physician shortage. [Now, for my medical colleagues reading, this is a highly discussed (debated) topic. Is there really a physician shortage? Is it more an exposure of the inefficiencies of healthcare delivery? How does physician burnout contribute to this shortfall of physicians? Etc, etc, etc). But like I said, the short and oversimplified answer is: there is a decreasing number of physicians (MDs and DOs) available to see the growing number of patients in the country. Patients are living longer because screening examinations are better, immunizations are developed and received (unless you don’t believe in vaccinations— a topic for another blog post), diagnostic technology has improved, and of course treatment, therapies, and medications are cutting-edge. There are more patients and fewer doctors— Enter the nurse practitioner and the physician assistant.

But who is everyone?

Here’s an explanation of the different medical providers you may be seeing:

MD vs DO

Practically speaking, these two are essentially the same. The difference is largely philosophical. An MD (a medical doctor) earned a degree from an allopathic medical school (what is generally considered a traditional medical school) the basic philosophy of which is disease eradication; it is studying disease states and learning the specific treatments (medication, surgery, radiation, etc) for each condition. A DO (a doctor of osteopathy) earned a degree from an osteopathic medical school which has a slightly different approach in its teaching philosophy. Osteopaths learn to diagnose and treat diseases like allopathic doctors however they have special emphasis on treating the body as a whole rather than focusing on specific conditions alone. Osteopaths also are required to learn manual medicine, also called manipulative treatment, which integrates special knowledge of the musculoskeletal system and structural body dysfunctions that reflect disease states and how they can be manipulated in a therapeutic way.

The difference really ends there. Both MDs and DOs:

Complete 4 years of medical school

Complete graduate medical education through internships, residencies and fellowships in any medicine or surgical specialty

Pass national board examinations to obtain (the same) state licenses

Use evidence-based medicine

Prescribe medications

NP vs PA

An NP (nurse practitioner, also referred to as an APRN advanced practice registered nurse) has first completed the undergraduate degree requirements to become a registered nurse and then pursued an advanced degree (at least a masters level degree but may be a doctorate degree) that allows them more training to diagnose and treat illness. Many NPs will choose to focus on a special area of medicine such as pediatrics, family medicine, women’s health, or mental health. A PA (physician’s assistant) has a masters level degree from a PA program that is generally at or affiliated with a medical school. Since the PA curriculum is modeled after the medical school curriculum, it is very likely you will see a PA in any setting you will see an MD or DO, including surgical suites.

Both PAs and NPs practice reasonably independently but there are definite legal distinctions and differing regulations between the two. PAs are licensed by state MEDICAL boards (like MDs and DOs). They must take state medical or state PA board examinations and maintain their certifications with regular continuing medical education and a recertification examination every 10 years. Their licensure is based on a team concept with specific requirements for a collaborative or supervisory role between physician and PA. PAs currently are required to have a physician in a supervisory role. NPs are licensed by state NURSING boards and must maintain their certification with regular continuing education and clinical hours; however recertification examinations are not required. A significant difference between NPs and PAs is that NPs can practice independently in 22 states (and the District of Columbia). This means they are not required to have physician supervision and have full practice authority. Other states are likely to follow. Both are trained to use evidence based medicine to examine, diagnose, treat and prescribe.

At the end of the day, who you choose for your care depends on your comfort level and your needs. You may need someone just to diagnose and treat your flu. You may need someone more experienced to follow you after your complicated 4-vessel bypass surgery. You may have a better connection with one provider than another. A nurse practitioner may have more allotted time than a physician. A physician may give you more reassurance than a PA. Your healthcare is important and if the demand is outnumbering the supply, something has to change. The increased number of providers is at least a start to help increase the patient’s access to care.

Blue crab, acrylic, Because I’m a cancer ♋️ . And because they’re yummy.

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