What a physician assistant or nurse practitioner can do for you
In the hospital, an urgent care clinic or doctor’s office, the provider who examines you could be a nurse practitioner (NP) or physician assistant (PA) instead of a physician (MD or DO).
You might wonder why a physician isn’t seeing you – after all, don’t they have the most expertise? Health care is a team effort, and skilled PAs and NPs work hand-in-hand with physicians to improve patient access and to help create more convenient, efficient patient experiences.
The differences among NPs, PAs and MDs
Typically, a physician is the leader of a patient’s healthcare team and has the final word among providers in the most complex treatment decisions. Their education includes at least four years of medical school after college, then they spend between three and 10 years in residencies and fellowships before they’re permitted to practice medicine independently.
“The rigor of physicians’ classroom education – including scientific prerequisites and intense testing, along with extended training taking care of patients – helps distinguish them from other healthcare providers,” says Andrew Thomas, MD, chief clinical officer for The Ohio State University Wexner Medical Center. “With seven to 14 years of training after college, physicians are well-positioned to understand the most complex cases and to perform procedures that require finely tuned skills.”
Nurse practitioners typically begin their careers as registered nurse (RNs) before going back to school for an advanced practice nursing (APN) degree. NPs complete a master’s or doctoral degree program and have training beyond the education to become an RN.
Regulations vary from state to state, but in Ohio, nurse practitioners are qualified to treat patients independently, in conjunction with a collaborating physician. They can perform physical exams, prescribe medications and order lab and radiology tests. Some with more advanced training are able to perform routine procedures.
“Many NPs have several years of experience in health care as registered nurses before becoming NPs,” says Sheila Mapes, APRN, interim director of advanced practice providers in The Ohio State University Health System. “Their training prepares them with the specialized knowledge and competency to practice in primary and acute care, and long-term healthcare settings.
“NPs can even specialize, both with a specialty chosen when they enter their program and with subspecialties chosen after graduation.”
PAs graduate from accredited, master’s level PA programs and must pass a national certification exam. They practice under a physician who can be called in when medical situations require even more advanced training.
Much like NPs, state regulations vary, but in Ohio, PAs can perform physical exams, interpret lab test results, diagnose illnesses, assist in surgeries, formulate treatment and preventive health plans and write prescriptions.
Why choose to see a PA or NP?
America is facing a shortage of physicians in primary care and in many specialties. High-quality, cost-effective, patient-centered care is increasingly being delivered by a team of individuals that includes not just physicians, but also NPs and PAs – along with pharmacists, dietitians and many others.
The addition of NPs and PAs to the patient care team can expand access to care and extend coverage for patients.
Many patients even choose to see a nurse practitioner as their primary care provider, based on their relationship with that individual or because the NP is able to provide specialized care because of their particular educational background.
“NPs can be seen for managing many stable chronic conditions,” Mapes says. “If the patient becomes less stable or their illness becomes more complex, then they may benefit from seeing a physician who works collaboratively with the NP.”
When a PA or NP is chosen for you
At the Ohio State Wexner Medical Center and many other hospitals, the most appropriate provider often is already chosen for individual situations.
“At organizations like Ohio State, standards for all providers are high – we scrutinize quality and safety, and we have high expectations for all staff,” Thomas says.
Both formal and informal processes identify excellent providers, based on their training and experience, for each circumstance.
“Some NPs who have been in practice for 10 or 15 years have much more experience than a faculty member who may be fresh out of training,” he says, “so there’s no one-size-fits-all rule.”
At large organizations like the Ohio State Wexner Medical Center, which contains multiple levels of expertise throughout the institution, you won’t encounter a provider who’s not properly trained for the situation.
“We have the ability to triage who needs to see whom,” he says. “For example, if you’re coming in for routine follow-up after surgery, you might see a nurse practitioner. If they recognize that something’s not going well, they’ll pull in their collaborating physician to further evaluate.”
It’s all about streamlining high-quality care to patients and making the patient’s experience timely, efficient and safe.