P.A.s now carry out many duties once handled by doctors: They perform physical exams, diagnose illnesses, assist in surgery, order lab tests and prescribe medication. With tens of millions of Americans newly insured under the Affordable Care Act, and a shortfall in the number of doctors to care for them, it’s little wonder that physician assistant is one of the fastest-growing professions in the United States. According to the Bureau of Labor Statistics, their numbers are expected to increase 38 percent between 2012 and 2022.
But not all patients embrace physician assistants. According to a national survey last year by the American Academy of Family Physicians, 72 percent of Americans prefer physicians for information related to their medical care, viewing them as more knowledgeable and experienced. Some doctors worry that patients are getting short shrift as the bottom line pushes physicians out of the examination room.
PAs and NPs are handling many tasks that were once the exclusive domain of doctors: They can write prescriptions in every state. In 21 states and the District of Columbia, NPs can practice autonomously. Some NPs and PAs substitute for residents at academic medical centers.
But there are differences between them and doctors. One distinction: What advanced practice practitioners are permitted by law to do can vary from state to state and even from hospital to hospital. For example, NPs can’t prescribe controlled substances in Florida. In some states, a supervising physician needs to be on site when a PA treats you; in other states, it’s not necessary. Nationwide, an NP’s or PA’s authority to admit you to a hospital is up to the hospital.
Training differs, too. Doctors and PAs train under the so-called medical model (though primary care doctors have about 23,000 hours of education and training, PAs have around 3,000). That teaches physicians to “work through a diagnostic process that directs the questions you ask, the physical you perform, the diagnostic studies and treatments. Nurse practitioners are educated under the nursing model, which stresses health promotion and education.
Ultimately, what an NP or PA does in your doctor’s office will depend on his or her experience, the setting, and the speciality. Often, each physician/PA/NP team will decide the best use of everyone’s skills on the health care team, and this can vary from practice to practice.
NPs and PAs are indispensable in handling everyday problems such as sore throats or urinary tract infections, freeing primary care doctors to handle more complex conditions. They can also prescreen patients, make hospital rounds, do follow-up care, monitor treatment, manage chronic conditions, and have a place in specialty care as well. They can be very good at the history taking, reviewing a patient’s records, and coordinating everything the specialist need. Also, many PAs work as surgical assistants. Though seeing an advanced practice practitioner is unlikely to lower your co-pay, it can help reduce overall health costs. Other benefits can include:
More research is needed to definitively assess when seeing a doctor might be preferable to seeing an NP or PA. Advanced practice practitioners have the know-how to play a primary role in diagnosing and treating common ills and an auxiliary role managing complex ailments. “Doctors are good for those 5 to 10 percent of patients whose symptoms don’t add up and need more detailed investigation. Some research suggests physicians may be more skilled in some areas. For example, one 2013 study found that family physicians who referred patients to a medical center better understood what the symptoms might suggest and were more likely to order the right tests than NPs and PAs.