MD, DO, PA, NP and More: Understanding the Differences

There are many kinds of BCH health care professionals who can help you stay healthy. We have DOs, MDs, NPs and PAs, to name a few. But who are all these providers? And, what training do they have?

Physicians (MD and DO)

The term “physician” refers to two slightly different medical degrees: MD (doctor of medicine) or DO (doctor of osteopathic medicine). Their training is similar in that both go through four years of medical school, another three to seven years in a residency program at a clinic or hospital and perhaps additional training in a fellowship program.

But they differ in a few key areas. MDs treat and diagnose conditions using conventional options such as prescription drugs and surgery. DOs use the same conventional options as MDs but tend to focus more on holistic health and prevention, considering in their treatment all parts of a person: mind, body and emotions.

Registered Nurses (RN), Nurse Practitioners (NP) and Clinical Nurse Specialists (CNS)

The differences in these types of providers are their training and the health care services they provide, called “scope of practice.”

The scope of practice of RNs includes:

• Performing physical exams and obtaining health histories
• Administering medications, wound care and numerous other personal interventions
• Interpreting patient information and making decisions about needed actions
• Directing and supervising care delivered by other health care professionals such as licensed practical nurses (LPNs) and nurse aides

Nurse practitioners (NPs) begin as RNs who then take advanced training. Because NPs are also RNs, they can do all that RNs do plus provide additional services, which include:

• Ordering, performing and interpreting diagnostic tests such as lab work and X-rays
• Diagnosing and treating acute and chronic conditions such as diabetes, high blood. pressure, infections and injuries
• Prescribing medications and other treatments
• Co-ordinating patients’ overall care (i.e., primary care function)
• Counseling
• Educating patients on disease prevention and positive health and lifestyle choices

Clinical Nurse Specialists (CNS) are registered nurses who have graduate-level nurse training at the master’s (MSN) or doctoral (DNP) level and have at least five years of experience. They are certified in an emphasis on specialist care for at-risk patients and/or populations. The scope of practice of the CNS includes, but is not limited to:

• Diagnosing and treating of acute or chronic illness in an identified population

Physician Assistants (PA)

PAs are licensed clinicians who practice medicine in every specialty and setting. Their education and practice emphasizes patient education, preventive care and chronic care management. PAs’ generalist medical training enables them to provide a wide spectrum of patient care and treat the “whole patient.” Their scope of practice includes:

• Taking your medical history
• Conducting physical exams
• Diagnosing and treating illnesses
• Ordering and interpreting tests
• Developing treatment plans
• Counseling on preventive care
• Assisting in surgery
• Writing prescriptions
• Making rounds in hospitals and nursing homes

PAs work in collaboration with a supervising physician. However, this does not mean they work under direct supervision of a physician.

Medical Assistants (MA)

There is another medical position, Medical Assistant, which should not be confused with Physician Assistant. Their level of training and clinical skills are much less than that of a PA and range of clinical duties include:

• Taking medical histories
• Explaining treatment procedures to patients
• Preparing patients for examination
• Assisting the physician during exams
• Collecting and preparing laboratory specimens
• Performing basic laboratory tests
• Instructing patients about medication and special diets
• Preparing and administering medications as directed by a physician
• Authorizing prescription refills as directed
• Drawing blood
• Taking electrocardiograms
• Removing sutures and changing dressings

Primary Care Providers (PCP)

A PCP is a physician (MD or DO), an NP or a PA who acts as the principal point of contact for a patient in our health care system. If you chose to see a physician as your PCP, there are two types — family medicine doctors (family practitioners) and internal medicine doctors (internists).

According to the American College of Physicians (ACP), “Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness.”

Family medicine doctors receive required training in pediatrics and obstetrics-gynecology, which is not in the required curriculum for internists. The American Academy of Family Physicians (AAFP) indicates that “Because of their extensive training, family physicians are the only specialists qualified to treat most ailments and provide comprehensive health care for people of all ages – from newborns to seniors.”