{"id":18952,"date":"2020-12-08T12:41:20","date_gmt":"2020-12-08T17:41:20","guid":{"rendered":"http:\/\/thepapergown.zocdoc.com\/?p=18952"},"modified":"2023-03-06T09:44:09","modified_gmt":"2023-03-06T14:44:09","slug":"whos-your-primary-care-provider","status":"publish","type":"post","link":"https:\/\/www.zocdoc.com\/blog\/guides\/whos-your-primary-care-provider\/","title":{"rendered":"The 4 Main Types of Primary Care Providers"},"content":{"rendered":"

Many of us say we\u2019re \u201cgoing to the doctor\u201d whenever we have a medical appointment. But are you actually seeing a doctor each time you step foot in an exam room or log on for a video visit? And if not \u2014 does it matter?<\/span><\/p>\n

In a primary care setting, you might meet with a physician (an MD or a DO), or you could see a nurse practitioner (NP) or physician assistant (PA). Each type of provider can specialize in primary care, diagnose and treat illnesses and write prescriptions, but there are differences in their training and the ways they practice.<\/span><\/p>\n

We talked with experts to help break down each specialty and understand the different roles providers play in primary care.<\/span><\/p>\n

The doctor will see you now: MDs and DOs<\/h3>\n

There are two types of medical degrees for doctors: An MD (doctor of medicine) and DO (doctor of osteopathic medicine). The term \u201cphysician\u201d can apply to either one.\u00a0<\/span><\/p>\n

Many of us are familiar with the MD designation, which means a doctor is trained in traditional Western medicine, also known as<\/span> \u201c<\/span>allopathic\u201d medicine.<\/span><\/a> To earn an MD, a physician must complete a four-year medical school program that focuses primarily on disease diagnosis and treatment, says Dr. Douglas L. Ambler, an internal medicine physician at Northwestern Medicine Regional Medical Group in Wheaton, Illinois.<\/span><\/p>\n

DOs also spend four years in med school, but their programs emphasize a holistic approach to medicine that includes evaluating a patient\u2019s lifestyle and environment in addition to their symptoms. DOs are also trained in<\/span> hands-on manipulative treatment<\/span><\/a> to diagnose and treat various conditions (this is sometimes compared to chiropractic treatment, but DOs and chiropractors are\u00a0 <\/span>not the same<\/span><\/a>).<\/span><\/p>\n

\u201cDuring medical school, doctors of osteopathy receive focused training in the musculoskeletal system,\u201d which prepares them to perform manipulative treatment, says Dr. Ada Stewart (an MD), American Academy of Family Physicians.<\/span><\/p>\n

Only about one-quarter of medical students in the US train to become DOs,<\/span> according to the American Medical Association<\/span>, but the American Osteopathic Association reports that the number of osteopathic physicians<\/span> is on the rise and even reaching record numbers.<\/span><\/a> DOs are also more likely to practice in primary care than MDs:<\/span> Fifty-seven percent of DOs are primary care providers<\/span><\/a>, compared to<\/span> less than 30 percent of MDs<\/span><\/a>.<\/span><\/p>\n

After medical school, the paths for MDs and DOs converge. Both have to meet the same residency requirements, which entail between three and seven years of clinical experience and <\/span>vary by specialty<\/span><\/a>.<\/span><\/p>\n

So from a patient\u2019s perspective, does it matter whether a PCP has an \u201cMD\u201d or \u201cDO\u201d after their name?<\/span><\/p>\n

\u201cI don\u2019t think in this day and age it makes a whole lot of difference,\u201d Ambler says, \u201cThe residency training programs are essentially going to be exactly the same.\u201d<\/span><\/p>\n

Non-physician providers: NPS and PAs<\/h3>\n

Physician assistants (PAs) and nurse practitioners (NPs) also commonly work in primary care.<\/span><\/p>\n

There are \u201clikely more similarities than differences between PAs and NPs\u201d in practice,<\/span> according to the American Academy of PAs<\/span><\/a>, but one difference is their training. PAs study general medicine; NPs select a population focus, such as women\u2019s health or pediatric care, and that population focus drives their training. Nearly 90 percent of NPs are certified in an area of primary care, according to the<\/span> American Association of Nurse Practitioners<\/span><\/a>.<\/span><\/p>\n

\u201cThe nurse practitioner training \u2026 looks at the patient as a whole,\u201d says Mariea Snell, assistant director of the Online Doctor of Nursing Practice program at Maryville University in St. Louis. \u201cWe are trained under a nursing model of care, which is a more holistic approach. PAs are trained under a medical model which focuses on disease and disease processes.\u201d<\/span><\/p>\n

The average PA student receives about three academic years of medical training, including more than 2,000 hours of clinical rotations,<\/span> according to the AAPA<\/span><\/a>. No matter what, PAs must be supervised by a physician in order to practice.<\/span><\/p>\n

Nurse practitioners are Registered Nurses that go on to earn either a master\u2019s or doctoral degree in nursing. Specific licensure requirements<\/span> vary by state<\/span><\/a> for NPs<\/span> (<\/span>and for PAs<\/span><\/a>). In some states, NPs have <\/span>full practice authority<\/span><\/a>, which means they can practice independently. In other states, they must practice under a written agreement with a physician, similar to PAs.<\/span><\/p>\n

You\u2019ll sometimes see PAs and NPs referred to as \u201cmidlevel providers.\u201d But that term is \u201cvery offensive,\u201d Snell says.<\/span><\/p>\n

\u201c<\/span>We are all providers of care. It\u2019s not \u2018one is better than the other,\u2019 \u201d she says. Snell recommends using the term \u201cprovider\u201d to describe all primary care providers, including MDs, DOs, PAs and NPs.<\/span><\/p>\n

A team approach<\/h3>\n

In many primary care practices, teams of providers including MDs, DOs, NPs and PAs work together.\u00a0<\/span><\/p>\n

In Ambler\u2019s office, for example, he works closely with PAs to care for his patients..<\/span><\/p>\n

\u201c[PAs] are almost like an extension of the physician they\u2019re working under in that practice,\u201d he says. \u201cWhile seeing a patient of mine, they may grab me and say, \u2018Hey, I\u2019m seeing Mrs. Smith right now, what do you think I should do?\u2019 \u201d<\/span><\/p>\n

NPs also work in primary care offices alongside physicians or run their own independent practices in states with full practice authority.<\/span><\/p>\n

Patients can also specifically request a non-physician provider for primary care.<\/span><\/p>\n

\u201cSome patients will select a PA as their PCP just because they might have seen this physician assistant a number of times, develop a relationship, and rather than seeing an MD they might have more access and ability to see the PA,\u201d Ambler says.<\/span><\/p>\n

However, you may not be able to officially designate a PA or NP as your PCP on your paperwork, Ambler says \u2014 it depends on your clinic\u2019s practices, your insurance provider\u2019s requirements and state regulations.<\/span><\/p>\n

But as far as patients are concerned, \u201cit becomes kind of a moot point,\u201d Ambler says. \u201c<\/span>Basically, the PA will function as the PCP,\u201d even if you have a physician listed as your official PCP.”<\/p>\n

The debate over independence for PAs and NPs<\/h3>\n

There have been<\/span> calls from PAs<\/span><\/a> and NPs to loosen restrictions on both groups so they can practice independently, especially with the<\/span> US facing a critical shortage of primary care physicians<\/span><\/a> and <\/span>fewer medical students specializing in primary care<\/span><\/a>.<\/span><\/p>\n

Proponents of full practice authority for NPs, for example, <\/span>argue that allowing NPs to practice independently helps extend care into rural and underserved areas.<\/span><\/a><\/p>\n

\u201cIn areas where you can have independent practice, you have all of these NPs that can come in,\u201d Snell says. \u201cIt is a great way to bridge that gap in access to care.\u201d<\/span><\/p>\n

On the other hand, states with licensure laws requiring physician oversight for NPs \u201climit NPs\u2019 ability to provide the care they are educated and nationally certified to provide,\u201d says Sophia L. Thomas, president of the American Association of Nurse Practitioners.<\/span><\/p>\n

Thomas says there are no studies that show requiring NPs to maintain written agreements with physicians improves outcomes for patients, but <\/span>critics of increased independence for PAs and NPs<\/span><\/a> argue that patients prefer to be treated by physicians, and that non-physician providers practice mostly in densely populated areas \u2014 not underserved communities.\u00a0<\/span><\/p>\n

Some physicians<\/span><\/a> also point out that the education and residency requirements for MDs and DOs are more rigorous than requirements for NPs and PAs.<\/span><\/p>\n

\u201cPatients oftentimes don\u2019t come into doctor offices with straightforward, simple textbook presentations of a disease process,\u201d Ambler says. \u201cThat\u2019s where the extra training of a physician of an MD\/DO really comes in handy to be able to decipher some of the nuances.\u201d\u00a0<\/span><\/p>\n

How should you choose?<\/h3>\n

When you\u2019re selecting a provider, the letters after their name can provide helpful information about their training, but that doesn\u2019t mean one type of provider is more qualified than another. You should also consider the provider\u2019s area of expertise.<\/span><\/p>\n

Snell, for example, has a background in infectious diseases and HIV. In one practice where she worked as an NP, \u201call of the physicians with an HIV-positive patient would send them to me,\u201d she says. \u201cEven though they had more advanced medical training in theory than I did \u2026\u00a0 the practice trusted me with those patients.\u201d<\/span><\/p>\n

Some patients remain skeptical of providers that lack \u201cMD\u201d after their name, Snell says, but in primary care, NPs and DOs are just as qualified to care for patients.<\/span><\/p>\n

\u201cThere are always going to be people who feel that way because they just don\u2019t understand the training and what the NP or PA can provide,\u201d Snell says. But \u201cI think it\u2019s shifting quite a bit \u2026 I\u2019ve seen a lot of people starting to say they would prefer to see the NP because of the holistic care they provide. Most of my patients that I have in primary care refuse to see anybody else.\u201d<\/span><\/p>\n

It\u2019s also important to choose a primary care provider you connect with on a personal level.<\/span><\/p>\n

\u201cAre you able to develop an easy line of communication and trust with this person?\u201d Ambler says. \u201cYou could have the smartest physician in the world, but if you have no connection, you might not have as good of a working relationship.\u201d<\/span><\/p>\n

\n

Ready to book a doctor’s appointment? Visit Zocdoc.<\/span><\/a><\/span><\/h1>\n","protected":false},"excerpt":{"rendered":"

MDs, DOs, PAs and NPs can all be PCPs. Does it matter which one you see? Here’s a breakdown. <\/p>\n","protected":false},"author":21,"featured_media":18949,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[227],"tags":[56],"class_list":["post-18952","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-guides","tag-primary-care","reviewer-dr-nassim-assefi"],"yoast_head":"\nThe 4 Main Types of Primary Care Providers - Guides<\/title>\n<meta name=\"description\" content=\"MDs, DOs, PAs and NPs can all be PCPs. Does it matter which one you see? 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