Should I See a Nurse Practitioner or Doctor?
How many times have you arrived at your doctor’s office for an appointment and been asked if you’d like to see the doctor or a nurse practitioner? This question may come as a surprise; chances are you just assumed that you’d see your doctor.
These days, however, that’s not necessarily the case. Nurse practitioners and medical assistants are now providing care that was once the domain of primary care doctors, even though they lack the broad training that primary care physicians have.
What is driving this trend?
Shortage of Primary Care Physicians
According to the Kaiser Family Foundation, there are currently 341,100 primary care physicians in the U.S. While that sounds like a significant number, the demand for primary care medical services — fueled by the nation’s growing and aging population— is outpacing the supply of doctors, according to a June 2020 report by the Association of American Medical Colleges. The projected shortages by 2033 are between 21,400 and 55,200 doctors.
It’s worth noting, however, that this projection was made before the COVID-19 pandemic. There is concern that the pandemic may drive even more primary care doctors into retirement.
The recent health crisis also put in sharp relief just how stretched our physician workforce is, especially among certain patient populations. When coupled with historical disparities in who has access to preventive care as well as treatment of chronic conditions such as diabetes and heart disease, the shortage is probably much higher than estimates.
This is why you may experience short appointments and long waits at your primary care provider’s office. Or why you may see a medical extender like a nurse practitioner or a physician’s assistant instead of your doctor when you finally get out of the waiting room.
This shortage affects physicians as well as patients, with 80 percent reporting they experience burnout and are at capacity or overextended, according to a 2018 survey by the Physician’s Foundation. The same survey found that nearly 25 percent of a physician’s time is spent on paperwork – not patient care.
In many cases, physician extenders like nurse practitioners are filling the patient care role.
The average primary care physician has a panel of 2,300 patients, more than two times what one study suggests they have to effectively treat their patients without physician extenders. Many primary care doctors have panels much larger, employing numerous nurse practitioners to fill the care gap.
Can Nurse Practitioners Fill the Gap?
Despite the fact that there are approximately 290,000 nurse practitioners licensed in the U.S., with nearly 90 percent certified in primary care medicine, you may not be familiar with the role they play in the health care system. There is, in fact, a fair amount of confusion among patients regarding the services they provide.
According to the American Association of Nurse Practitioners, these healthcare professionals are registered nurses who have continued their studies to obtain at least a master’s degree in nursing. They must complete at least 1,000 hours of clinical practice in a specialized area, such as primary care, family medicine or pediatrics. Generally speaking, nurse practitioners are trained to perform physical exams; order, perform and interpret diagnostic tests, such as x-rays and lab work; diagnose and treat acute and chronic conditions; prescribe medications; and provide patient education on healthy lifestyles.
They typically work in clinics, hospitals, urgent care centers and private doctor’s offices. Given the number of patients requiring care each day, the majority see three or more patients per hour.
The rules and regulations in the state in which nurse practitioners are licensed determine the scope at which they may use their skills, and whether they must work with a supervising physician. At the highest level, a nurse practitioner may have full practice authority (FPA), meaning that she works under the exclusive authority of the state Board of Nursing. This is the case in 22 states and Washington, D.C.
What's the Difference Between a Nurse Practitioner and a Doctor?
First, primary care doctors are required to have more years of medical education and training than nurse practitioners. NPs go to undergraduate nursing school, and then they typically earn a masters degree in advanced nursing. They must also pass a national certification exam in their specialty and pass state licensing requirements.
Physicians, on the other hand, go to medical school for four years, then at least three years of residency. In all, it can take more than twice as long for a primary care physician to become fully trained than a nurse practitioner.
Second, a primary care doctor can provide years of care continuity, which helps lower hospitalization rates and emergency room usage while increasing preventive care. A 2018 study in the British Medical Journal found that continuity of care actually lowered mortality rates. When your care is being passed from one extender to the next, it’s hard to maintain that continuity of care, even if it’s within the same practice.
What is the Difference Between a Nurse Practitioner and a Doctor?
The main differentiator —which is substantial — is the primary care doctor’s level of knowledge, training and experience. According to the American Academy of Family Physicians, medical school students must pass two “step” exams and periods of clinical instruction to earn their MD degree, at which point they start three years of clinical training as a resident. Near the end of their residency doctors take a certification exam and apply for licensure from their state, which determines where they can practice as a board-certified family physician.
For insurance companies, there is a cost savings when utilizing nurse practitioners in a primary care role, since health insurers can pay them less than their MD colleagues. And yet there is a cost to patients if they don’t receive the level of care needed, especially when they have one or more chronic conditions.
The primary care doctor is also a patient’s personal doctor. In that role the physician is responsible for many of the patient’s medical and health care needs. This may include chronic, preventive and acute care in both inpatient and outpatient settings. But there is a great deal of pressure on doctors to see as many patients as possible each day.
This is where you may want to consider an MDVIP-affiliated physician. Because they see fewer patients, they don’t have to rely on extenders like nurse practitioners to see patients. Instead, patients see their doctor when they come in for appointments. The 1,000-plus physicians in MDVIP’s national network are all doctors, many board-certified in specialties like family medicine or internal medicine. Plus, they’re practitioners who have dedicated their careers to providing personalized, preventive care.