America’s health care sector continues to expand due to factors such as aging Baby Boomers, increased ACA insurance coverage, and general population growth. Consequently, more medical practices are taking advantage of a growing pool of advanced practice professionals (APPs), most frequently physician’s assistants (PAs) and nurse practitioners (NPs). However, these medical professionals are not straight-across replacements for MDs. Health care clinics must evaluate the full scope of the needs of their community to determine when they can or should manage their patients without that higher level of expertise and leadership.
Filling Gaps and Responding to Needs
The demand for PAs and NPs has never been greater. Over a three-year period from 2014 through 2016, the PA rose in “most-placed health care career” ranking from sixth to fourth, behind family medicine MDs, internists and hospitalists. And their work most often complements that of their supervising medical doctor. Common functions they perform include prescribing medications, gathering medical histories, conducting exams and assessments, and diagnosing injuries and common illnesses. In these capacities, the PAs and NPs complete vital medical services so the medical doctor can attend to more urgent medical concerns.
But the Roles Differ
Regardless of the obvious benefits they offer, the role of the APP differs significantly from the role of the medical doctor:
By Education
Both PAs and NPs receive advanced degrees and certifications. In most states, physician assistants must complete a medical degree, be certified by a qualified PA program and finish a one-year clinical rotation. Nurse practitioners need a master’s degree in nursing and most states require them to be certified by a national organization.
Physicians, on the other hand, must complete the four-year pre-med degree, followed by two more years for the medical doctor (MD) designation, and then an additional three to seven years of residency, depending on the specialization. Doctors are then board certified at the national level. Their education is much more extensive than that of the APP.
By Authority
While both PAs and NPs enjoy a relatively high level of autonomy, each acts as an agent of the medical doctor, who also assumes the legal liability if staff in either position make an error. Ultimately, the medical doctor not only holds the authority of what happens within the practice, but they are also trained to assume and manage that power ethically and responsibly. And, outside of the typical health care demands, doctors are the only clinical authority for emergent, urgent and rare health care cases.
The rising demand for health care services requires more providers performing more functions to meet that growing need. While PAs and NPs are, without question, invaluable members of every medical team, the fully trained medical doctor should always be its leader.
