Written by Barbara Hoefener, FNP 2020
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What is the difference between a physician and a nurse practitioner and a physician assistant?
Nurse practitioners (NPs) and physician assistants (PAs) are increasingly mentioned as a collective solution to the nation’s primary health care shortage by providing safe, cost-effective patient care, preventive care, and health promotion.
MD, NP, PA can all Diagnose and Treat patients independently. All can order labs, imaging and dispense medications. All can open their own practice and see patients. All need a state license along with a board/ national certification, and pass a criminal history and background check. Insurance pays NPs and PAs for their work, most at a discounted rate of 85% instead of 100% from MD billing.
The big difference with NPs is state laws for supervision. Some states allow NP to practice to full scope without any oversight, thus NPs also have full liability. Some states require MD “oversight” meaning the MD may never meet a patient or look at their chart, however the MD must review a certain percentage of charts by the NP. PAs must work with MD oversight and have 15% of their charts reviewed.
Schooling & Certification
-MD- has 4 years for medical school, a minimum of three years for residency, and 1-3 more if for specializing with a fellowship. Learns from a Disease centered, emphasis on the biologic/pathological aspects of health, assessment, diagnosis, and treatment.
Medical board certification needs to re-certify every 7-10years.
NP – APRN - Advanced Registered NP - has a Master of Nursing or PHD of Nursing with Residency – 1-3 years. Learns from a Patient-centered model: Besides health assessment, diagnosis, and treatment, NPs focus on health promotion, disease prevention, health. Has a bachelor of nursing/ RN with advanced education and clinical training to provide a wide range of health care services, including the diagnosis and management of common as well as complex medical conditions.
National Certification: Neonatal, Pediatric, Family, Women’s Health, Geriatric, Psychiatric, or Acute care. Must re-certify every 5 years.
PA – has a masters with 1-2 yr residency. Learns from Medical/physician model: Disease centered, emphasis on the biologic/pathological aspects of health, assessment, diagnosis, and treatment. Team approach relationship with physicians. National Certification as PA. Requires 100 hours of Category 1 CME every 2 years and exam every 6 years
Scope of Practice for Nurse Practitioners
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Professional Role
Nurse practitioners (NPs) practice in nearly every health care setting including clinics, hospitals, Veterans Affairs and Indian Health Care facilities, emergency rooms, urgent care sites, private physician or NP practices (both managed and owned by NPs), nursing homes, schools, colleges, retail clinics, public health departments, nurse managed clinics, homeless clinics, and home health. NP practice includes, but is not limited to, assessment; ordering, performing, supervising and interpreting diagnostic and laboratory tests; making diagnoses; initiating and managing treatment including prescribing medication and non-pharmacologic treatments; coordinating care; counseling; and educating patients and their families and communities.
As licensed, independent practitioners, NPs practice autonomously and in coordination with health care professionals and other individuals. NPs provide a wide range of health care services including the diagnosis and management of acute, chronic, and complex health problems, health promotion, disease prevention, health education, and counseling to individuals, families, groups and communities. They may also serve as health care researchers, interdisciplinary consultants, and patient advocates.
The nurse practitioner role is consistent with the APRN consensus model practicing in the population foci of family, pediatrics, women’s health, adult-geriatrics, neonatal, and psychiatric mental health. The scope of practice is not setting specific but rather based on the needs of the patient (APRN Consensus Model, 2008).
Education
NPs are advanced practice registered nurses who obtain graduate education at the masters, post-master’s or doctoral level and obtain national board certification. NP education programs follow established educational standards which ensure the attainment of the APRN core, role core, and population core competencies. Educational preparation provides NPs with specialized knowledge and clinical competency which enable them to practice in various health care settings. National NP education program accreditation requirements and competency-based standards ensure that NPs are equipped to provide safe, high-quality, cost effective patient centered care upon graduation. Clinical practice competency and professional development are hallmarks of NP education.
Accountability
Each NP is accountable to patients, the nursing profession, and the state board of nursing. NPs are expected to practice consistent with an ethical code of conduct, national certification, evidence-based principles, and current practice standards.
Responsibility
The patient-centered nature of the NP role requires a commitment to meet the evolving needs of society and advances in health care science. NPs are responsible to the public and adaptable to the dynamic changes in health care. As leaders in health care, NPs combine the roles of provider, mentor, educator, researcher, advocate, and administrator. NPs take responsibility for continued professional development, involvement in professional organizations, and participation in health policy activities at the local, state, national, and international levels. Five decades of research affirms that NPs provide safe, high-quality, cost effective patient centered care.
© American Association of Nurse Practitioners 1993 Revised 1998, 2002, 2007, 2010, 2013, 2015, 2019 Reviewed and revised by the AANP Fellows at the Winter 2015 Meeting
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NP Scope of Practice Laws- Interactive
PA Scope of Practice Laws- Interactive
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The only thing that truly separates doctors from nurses
SHIRIE LENG, MD | PHYSICIAN | APRIL 3, 2013
http://www.kevinmd.com/blog/2013/04/separates-doctors-nurses.html
Academic Medicine, journal of the American Association of Medical Colleges, has sent out a recent call for articles addressing the 2013 question of the year: “What is a doctor? What is a nurse?” Thirty years ago this would have been an absurd question. Not only would it have been absurd for doctors and nurses, but for patients too. Roles were clearly delineated within the disciplines, and the white coat indicated a doctor and the white uniform and cap identified the nurse.
There are several reasons why we have to ask the question posed by Academic Medicine. A big reason is the entry of women into the field of medicine. Another is the development of advanced degrees for nurses. The computerization of medical records has spurred increases the need for physician extenders to support practices. A huge reason recently has been cost-containment considerations. The erosion of the doctor as an ultimate authority figure and the rise of patient autonomy have leveled the field as well. To some extent access to education is in the mix also.
Educational level is usually part of the definition of a doctor or nurse. This is no longer a reliable indicator. A doctor has an undergraduate degree and an MD. But a doctor might be a DO also, a doctor of osteopathic medicine. A nurse has an undergraduate degree in nursing. Except that a nurse might have an undergraduate degree in something other than nursing, and get the nursing training later in a master’s degree program. Up until relatively recently you didn’t have to have a BSN to be a nurse, an associates degree was enough. Now a nurse might have a master’s degree or a PhD. A nurse practitioner has a master’s degree. A physicians assistant might also.
Authority used to be used to separate doctors from nurses. Doctors can prescribe medicines. But now so can many advanced-practice nurses. Doctors can write orders. So can nurse practitioners. Doctors can examine you and diagnose you. So does your NP.
Nurses and doctors used to look different. The physical appearance and dress of nurses and doctors in hospitals today is actually emblematic of the blurring of the lines of identity that have characterized medicine in recent years. A doctor might wear scrubs; a nurse practitioner might wear a white coat; in the operating room, everybody wears the same thing. Clothing has long been a tangible symbol of turbulent times. The casting off of corsets was a signal of relaxing social restrictions. The shock of a woman wearing pants coincided with women entering the workforce. Burning bras were a way of protesting gender inequality. It is no accident that the shedding of the nurses cap happened around the same time nurses became college educated.
Lifestyle and money? Nope. A primary care doctor makes less than a nurse anesthetist. Some doctors don’t take call anymore, and many nurses do, even those without advanced degrees.
Surely knowledge, skill, and ability separate nurses from doctors? Of course not. Your experienced floor nurse knows way more about medicine than your average intern. Physicians assistants can sew up wounds and assist in surgery. A person who becomes a nurse is just as smart as a person who becomes a doctor, which has always been true but not always acknowledged. An MD is just a piece of paper that gives a person permission to start learning how to be an actual doctor. An RN is much the same. Clinical experience and training are the only things that matter materially to patients. Some argue that training level is also part of the differences between physicians and nurses. Doctor’s clinical training in a formal educational system is usually longer. So you could equivocally say that a doctor has longer training.
I would suggest to my readers that the only thing that truly separates doctors from nurses is ultimate responsibility. The editor of Academic Medicine says in his introductory remarks introducing the question that his daughter was trying to decide between medicine and nursing. This is the decision she must make. Does she want to live with the ultimate responsibility for every patient under her care? Because of our investment of time and money, and presumably because of the economic and social standing granted to us, we doctors bear this ultimate burden. This is not to say that nurses don’t also have a responsibility to their patients and their field, or that they haven’t invested just as much time and money.
I have been both a nurse and a doctor, and am a huge proponent of the expanded role of nurse practitioners. But the law and society have laid the ultimate privilege and burden on the person that people call “doctor.” That’s the difference.
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