Who’s who at the doctor’s office

With so many people wearing white coats and wielding stethoscopes, it’s becoming more difficult to tell who is showing up in the exam room when you make an appointment with your doctor. It might be a physician’s assistant, working under the supervision of a doctor to diagnose or treat a minor injury. Or maybe it’s a registered nurse (RN) who’s come to counsel you on your recent diagnosis or take your vitals. Perhaps you’re in a nurse practitioner’s OB-GYN practice and won’t see a doctor at all.  

A shortage of primary care physicians and a growing demand for them has increased the need for other medical professionals, including physician assistants (PAs) and nurse practitioners (NPs). While they’re able to offer many of the same services — and do so at a lower cost — patients generally prefer physicians, according to an American Medical Association survey.
Chances are, your next appointment will involve these other professionals, and there’s evidence they can increase the quality of your care.

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Here’s a roundup of the people you may encounter and their levels of expertise:

Medical Doctor (M.D.): Your physician
Your doctor spent several years in school before she saw her first patient. She earned an undergraduate degree before going to medical school, and followed that up with a residency program of three to seven years, according to the American Medical Association. This training culminated with her earning a license to practice medicine. She also had the option of becoming board-certified in a specialty.

Your doctor has put in serious time to get where she is. As such, she can diagnose conditions, prescribe medication and perform other tasks we associate with practicing medicine.

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Physician Assistant (PA): Your doctor’s right hand
PAs are not to be confused with medical assistants, who have considerably less training. PAs require a minimum of a master’s degree, according to the Bureau of Labor Statistics. The bureau estimates employment in the field will grow by 38 percent from 2012 to 2022. For that reason, if you haven’t seen a PA yet, you likely will soon.

“You’re more likely to see a PA in a surgical center with your doctor” rather than a clinic, says Michelle Katz, a health care advocate and author of Healthcare Made Easy. PAs must practice under the supervision of a doctor, and their day-to-day job involves frequent collaboration and confirmation from a physician.

Many specifics of PA care vary from state to state. In some states, for instance, they can stitch up a wound, deliver babies and prescribe controlled substances after registering with the Drug Enforcement Administration (DEA); in others, they cannot. Depending on the state, PAs must confer with their supervising physicians before diagnosing a condition or interpreting lab results, Katz says.

Broadly, PAs can:
● Diagnose injuries and illnesses.
● Examine patients.
● Order lab tests and interpret results.
● Recommend treatment.
● Prescribe most medications.
● Assist in surgeries.
● Assist in complex cases.

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Nurse Practitioner (NP): A nurse with advanced training
As with PAs, employment of nurse practitioners is expected to grow fast — by 31 percent from 2012 to 2022, according to Bureau of Labor Statistics. NPs are known as advanced practice registered nurses (APRNs). They’ve gone to nursing school and normally must have a master’s degree and additional clinical training before becoming licensed.

“Because NPs are trained as registered nurses first, they see the patient from a different perspective and have nursing values, treating the patient as a whole along with the medical diagnostic side,” Katz says. In other words, doctors may be more focused on finding a diagnosis and treatment, while nurses and NPs can commit more time to patient counseling.
Unlike PAs, NPs don’t always have to practice under a doctor’s direct supervision. In some states, they can have their own medical practices and even manage high-risk cases on their own. 

NPs can:
● Diagnose injuries and illness.
● Examine patients.
● Order and interpret diagnostic tests.
● Develop treatment plans.
● Prescribe most medications, including controlled substances, in most states.
● Assist in surgeries.
● Deliver babies.

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Registered Nurse (RN): A staple in patient care
Registered nurses (RNs) generally have a bachelor’s or associate’s degree. They’ve gone through numerous clinical hours — the exact requirements vary by state — and a licensing process. The field is projected to grow rapidly, though not at the same rate as NPs and PAs, by 19 percent from 2012 to 2022. RNs have been around since the early 1900s, much longer than PAs and NPs.

RNs can:
● Monitor patients.
● Confer on diagnoses.
● Supervise other members of a health care team.
● Facilitate the treatment plan outlined by a patient’s doctor.
● Counsel patients and their families about their health care, prevention and treatment.

Supporting staff
Of course, these aren’t the only people you’ll see in the clinic or hospital. You’ll likely encounter technicians who might draw your blood, licensed practical nurses (LPNs) who take your vital signs and administer medication, or medical assistants who may escort you to the exam room and get your medical history.

Each person within the health care practice has gone through a certain level of education and training; each plays a specific role, but those roles may vary from clinic to clinic and state to state. And although your knee-jerk reaction may be to prefer your M.D. for every visit and health care exchange, the team working with her may be able to provide more time and a broader range of skills than the doctor alone.