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What’s In a Name? Nurse Practitioners and Physician Assistants Explained

More and more patients are seeing a nurse practitioner (NP) or physician’s assistant (PA) in a variety of health care settings, so it’s a good idea for patients to understand why they might see one instead of, or in addition to, seeing their doctor for certain hospital or clinic visits.

Part of a group of caregivers known as advanced practice provider (APPs), NPs and PAs are trained and equipped to diagnose patients, prescribe many treatments and medications, and generally manage overall care. Dating back more than 50 years, the use of NPs and PAs often means faster appointment times and helps ensure that patients are getting the right care, at the right time, from the right provider.

NPs and PAs also can ease the high cost of health care for patients and address the looming primary care shortage. According to the American Association of Nurse Practitioners (AANP), last year almost 90% of NPs were certified in primary care, while fewer than 15% of physicians entered a primary care residency. NPs are having a positive impact on both access and the time patients spend in waiting rooms; in fact, 60% of NPs see three or more patients per hour.

Catherine G. Brown, CRNP, MSN, who directs the UAB Medicine Department of Advanced Practice Providers, notes the growing importance of improving patient access.

“Because NPs and PAs have the ability to provide a full range of care in many clinical settings, especially primary care, we are helping to close the gap in the shortage of physicians,” Brown says. “Patient volume is up in significant numbers because of increases in population and specifically in the aging population, but medical schools aren’t turning out enough providers in most of the disciplines to meet demand. We want the physicians’ efforts spent on those patients who, without a doubt, need a doctor. But NPs and PAs can certainly care for patients who are within their skill set. They have the qualifications and experience that you would expect from so much clinical preparation.”

The rigorous training and credentialing NPs and PAs undergo are not the only reasons patients can have full confidence in the care they receive from an APP. Brown says that, through collaboration, NPs and PAs learn team-specific approaches in order to match the level of care physicians provide.

“In the Emergency Department and at Urgent Care, there is a physician present, but they are seeing the higher acuity patients,” Brown says. “Sometimes a patient might arrive at the ED or the Urgent Care clinic and we learn they are more ill than they thought, and if that’s at a serious enough level, a physician is on hand to see them.”

“NPs and PAs at UAB don’t have their own brand or style of medicine,” Brown continues. “We do see patients independently, but we are part of a collaborative care team. Our physicians, when they work with any advanced practice provider, NPs or PAs, have an expectation that the APP provides the same care that the physician does. We are held to the same standards of quality and patient safety. When our trauma surgeons are in the OR instead of the bedside in the ICU, they know that the PAs and NPs on their team are trained to deliver the same level of care that they would if they were at that bedside. We’ve been trained by our physician colleagues to walk in their shoes.”

In many clinics, patients have come to know their PA or NP well. And because they have established a relationship after a number of visits, they want to have that same interaction, so they actually ask to see the NP or PA instead of their physician. Brown says that this change benefits both physicians and patients.

“Physicians, especially in more specialized practices, or if they perform procedures or do surgeries, have significant demands on their time,” Brown says. “NPs and PAs typically have more time to discuss issues with patients and also tend to communicate on their level. A less academic approach, using plain language, is a very nursing-centric method. One thing we learn in nursing school is that you will have to do patient education, such as teaching them to do home procedures, and that calls for having conversations about their care from the patient’s perspective.”

Training and Qualifications

NPs must complete a master's degree or doctoral program and have advanced clinical training beyond their initial professional registered nurse preparation. NPs enter practice with 6-plus years of post-secondary education and clinical preparation, and they undergo rigorous national certification, periodic peer review, clinical outcome evaluations, and adhere to a code of ethical practices. Self-directed continued learning and professional development is also essential to maintaining clinical competency. NPs promote quality and improve clinical outcomes through participation in both professional and lay health care forums, conducting research, and applying findings to clinical practice.

Certified PAs are not studying to become doctors; they are licensed and certified health care professionals who practice medicine in partnership with doctors and bring a breadth of knowledge and skills to patient care. PAs are educated in accredited graduate-level programs averaging 27 months in length. They’re trained in medical and behavioral sciences and complete rotations in internal medicine, family medicine, surgery, pediatrics, obstetrics and gynecology, emergency medicine and geriatric medicine. Following graduation from an accredited PA program, PAs must pass a rigorous national certification exam that tests them on everything from taking a patient history to diagnosing and treating complex medical issues. To maintain certification, PAs document continuous study and pass a recertification exam every 6-10 years.

Practice

NPs are licensed in all states and the District of Columbia, and they practice under the rules and regulations of the state in which they are licensed. They provide high-quality care in rural, urban, and suburban communities, in many types of settings. Autonomously and in collaboration with health care professionals and other individuals, NPs provide a full range of primary, acute, and specialty health care services, such as women’s health and acute care, and they practice in sub-specialty areas such as orthopaedics, oncology, and cardiovascular.

PAs are licensed in all states and the District of Columbia and practice under the rules and regulations of the state in which they are licensed. Certified PAs obtain medical histories, examine, diagnose and treat patients, order and interpret diagnostic tests and recommend and implement treatment plans. PAs can perform minor surgery and assist in major surgery, instruct and counsel patients, order or carry out therapy, and prescribe medications.

Benefit

NPs treat the illness and manage “whole person” care. They place an emphasis on both diagnosing and managing illness and counseling patients toward prevention through better lifestyle and health decisions. In providing both high-quality care and health counseling, an NP’s unique combination of nursing and medical care often leads to better outcomes, which can translate to fewer ER visits, shorter hospital stays, and lower medication costs.

Certified PAs work with doctors as an integral part of the health care team. A physician is available to consult with the PA when needed and stays informed about the care a patient is receiving. The physician-PA team is an effective approach to the delivery of health care because it decreases waiting time and may also increase patients’ time with the health care provider. Because they are educated and certified in general medicine, certified PAs in any specialty are able to evaluate the whole patient and often play a key role in early detection and prevention.