By Seth Lammming and Hannah Faeben
From PHN Issue 51, Winter 2023
At some point in time, you’ve probably been in a doctor’s office or medical facility and noticed all sorts of letters after people’s names. MD, PA, DO, NP, RN, the list goes on. The alphabet soup can get confusing. In this article, we will break down the basic differences between physicians and mid-level providers and what some of these letters mean.
A healthcare provider is someone who provides care for physical or mental health and wellness. There are several different types of healthcare providers that can diagnose and manage health problems. There are primary care providers who manage your general ailments, like the common cold, and some chronic conditions like high blood pressure. There are then surgeons who do surgery—they are kind of like the mechanics of medicine. Lastly, there are specialists who focus on specific areas of medicine. A nephrologist, for example, is an expert in medicine involving the kidneys. Nurses are not healthcare providers, but they are vital members of the care team and work with providers to help coordinate and manage care.
A medical doctor (MD) or doctor of osteopathy (DO) is a physician. There are two different degrees you can obtain to become a doctor. MDs and DOs both complete 4 years of graduate studies after college. In their education, they learn about the various organ systems and how the human body works, and how different disease processes can affect it. They also complete clinical rotations during their education where they get hands-on experience in the field. The main difference between MDs and DOs is that DOs have a greater focus on primary care and preventative care during their schooling and also learn something called osteopathic manipulative medicine (OMM) that some DOs will incorporate into their practice. OMM incorporates aspects of massage and tissue manipulation to treat health problems. After medical school, MDs and DOs go to residency training in their desired field of medicine, and they then complete 3 or more years of training under the supervision of an experienced physician. After residency, some doctors will complete even more training called a fellowship where they can specialize even further. Overall, MDs and DOs have the same scope of practice, which means they serve the same role. They both are leaders of the healthcare team and diagnose and manage health problems by prescribing medications and treatments and sometimes performing surgeries.
A physician’s associate/assistant (PA) is a mid-level provider. They have a master’s degree. PAs do 2-3 years of school after college where they similarly learn about various organ systems, the human body, and the disease processes that can affect it. They also complete some hands-on clinical rotations while they are in school. Some PAs will go on to complete a PA residency where they can get more training, but it is not required, and some will go directly into their desired field. PAs can diagnose health problems, prescribe medications, oversee care, and perform minor procedures like stitching surgical wounds. They work alongside doctors and act mostly independently but still are technically under the supervision of a physician.
PAs will consult their supervising doctor if they have questions or need a more expert opinion.
A nurse practitioner (NP) is a mid-level provider. In a lot of ways, they are very similar to a PA in how they practice. They also have a master’s degree. NPs first get a bachelor’s in nursing sciences, have clinical experience as an active registered nurse, and then get additional clinical training to be a healthcare provider. NPs can diagnose health problems, prescribe medications, oversee care, and do some procedures, though normally fewer procedures than PAs. NPs can practice medicine without physicians in some states. However, they normally work alongside physicians as a team, consulting a physician if they need a more expert opinion.
Nurses (RNs): Typically, it takes 2-4 years to become an RN. Exactly how long it takes depends on if the nurse obtained an associate’s degree in nursing (ADN), which takes around 2 years, or obtained a bachelor’s in nursing science (BSN), which takes around 4 years. Nurses are not providers, but they serve a very important role in the healthcare team. They do not diagnose medical problems, prescribe medications, or do any surgeries. Nurses are trained to monitor and assess patients and notify a healthcare provider if something is wrong. Nurses have a lot of different roles in different health care settings. Here are some examples: Nurses “triage” patients, which means nurses assess someone and decide how soon they need to see a provider. Nurses are trained to do a lot of direct care with patients, such as administering meds, wound care, case management, and more.
So, is it better to see a doctor (MD or DO) or a mid-level provider (PA or NP)? It depends, but if you are seeing a PA or NP, then it’s because they are qualified to work with you and provide you with excellent care! It’s OK that they’re not physicians! Most healthcare settings are team-based, meaning physicians, NPs, PAs, and other members of the healthcare team work together.
It’s common for people to assume that doctors will provide better care because they went to school longer. NPs and PAs can do a lot of the same things as physicians, and depending on their personal experience, they could even be better at it! All healthcare providers should refer to “guidelines” when making treatment decisions or providing care. Guidelines are instructions that get groups of experts to review and update them every few years. Guidelines provide the most updated information about different healthcare problems and the best ways to treat them. Regardless of whether you’re seeing a PA, NP, or a physician, they should be looking at similar guidelines for treating you.
Whoever you are being seen by, a good healthcare provider treats you with respect and takes the time to answer your questions and concerns. When you are thinking about whether or not a provider is good, it might be helpful to ask yourself some questions about the experience you had with a provider. Did the provider treat you with kindness and respect? Did the provider give you enough time and space to express your concerns? Do they explain why they are following a certain treatment plan, and is it up to date with current medical guidelines? If the answer is no to any of those questions, that particular provider might not be doing a great job—and those qualities have very little to do with the letters after their name.
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