Physical with M.D. or N.P.? Who do you go to?

[essnce629]

I see both! My family doctor has her own practice with one NP. I always request the appointments for me and the kids with the doctor, but if she's not available for whatever reason or is booked, then I schedule with the NP. She's been great and at times she's called in the doctor to consult with while I'm there. Both are women, which I prefer. If anything, the NP is even more personable than the doctor, although both are great, don't rush, and my doctor is a DO.

Sent from my SM-J700P using Tapatalk

[JBaxter]

I see both and have no issues with either NP or PAs. LOL 2 of my sons are PAs and I run issues by them before I even call my DR office.

[dogmom]

It depends on the doctor and the NP and the patient. If you are basically healthy with only common problems, like hypertension, the NP may have more time to spend counseling you on subjects of actual use to you since they cost less and their time is not as squeezed. As far as research it tends to all show a wash, but there needs to be more on this subject.
https://www.ncbi.nlm.nih.gov/books/N...?report=reader

[bcafe]

I would be interested to know one's feelings about PAs. The blanket statements here are interesting, but I realize the main one comes from a physician.

[dogmom]

I would be interested to know one's feelings about PAs. The blanket statements here are interesting, but I realize the main one comes from a physician.

I feel the same way about PA, but I am much more familiar with NP being a nurse and being in the Northeast which has a stronger NP history. NP can work on their own license and PA need to be affiliated with a physician. NP come from a nursing background and need to have both a nursing background which tends to me more holistic and experience in medical dual diagnosis. PA tend to focus on exam and dual diagnosis. It that is a big generalization. Here PAs tend to be used more in surgical practices to help the surgeons to pre and post procedure follow up while NP are the ones you fine in acute and primary care. But that is regional. Other places use them differently.

[NCGrandma]

I feel the same way about PA, but I am much more familiar with NP being a nurse and being in the Northeast which has a stronger NP history. NP can work on their own license and PA need to be affiliated with a physician. NP come from a nursing background and need to have both a nursing background which tends to me more holistic and experience in medical dual diagnosis. PA tend to focus on exam and dual diagnosis. It that is a big generalization. Here PAs tend to be used more in surgical practices to help the surgeons to pre and post procedure follow up while NP are the ones you fine in acute and primary care. But that is regional. Other places use them differently.

As dogmom says, there are definitely regional/state differences in practice patterns and in whether a PA or NP can have an independent practice or needs to have a collaborative or supervisory relationship with a physician.

These change periodically but this map of NP scope of practice by state is pretty current:
https://www.aanp.org/advocacy/state/...ce-environment

I couldn’t find a similar map for PAs, but here’s a State by state table. (Note: this is from the AMA website so it is based on an assumption that physicians should always supervise PAs and, probably, NPs)
https://www.ama-assn.org/media/21466/download




Sent from my iPad using Baby Bargains

[dogmom]

I couldn’t find a similar map for PAs, but here’s a State by state table. (Note: this is from the AMA website so it is based on an assumption that physicians should always supervise PAs and, probably, NPs)
https://www.ama-assn.org/media/21466/download




Sent from my iPad using Baby Bargains

In the US PAs always work off a physician’s license (with their own license requirements) and always need supervision. Doesn’t mean physician needs to be in room. NP have full authority in 20 states and can work independent of physicians and can bill separately.

For the patient there is more a difference between individual practitioners than licensure. It matters more if you are choosing which one to go into as a profession. People still choose PA school, sometimes because that’s more common in the area. Sometimes it’s because they want to avoid that “nursing theory stuff” and be more medically based.

You can also have Nurse Anesthetist or Psych Nurse specialist which has no corresponding PA area. My DD has her meds managed my a psych NP. I find her much more holistic than Psychiatrists we’ve gone to.

[cckwmh]

I have been reading this thread for days and have been thinking about how to respond. I am a PA, in Massachusetts, which is a collaborative state for NPs. I have always worked in a specialty (dermatology). Our practice has MDs, NPs, and PAs. I have my own panel of patients, many who I have inherited from the MDs, who prefer to see me. I do schedule more time per patient than the MDs. Even though I am in dermatology, I do spend a lot time discussing lifestyle modifications , weight loss, stress management, smoking cessation, mental health, and birth control.

Each state is different with the laws about PA practice. In Mass, it is an written agreement between the PA and MD that determines the level of oversight. I think it depends on the practitioner rather than the degree. I have had wonderful NP, PAs, and MDs take care of me and my family and have had some not so wonderful ones.

I know posts above bring up what level of knowledge/education and what people do not know. I think the best providers are well aware of their scope of practice, ask for help/refer. That is the whole structure of what the PA profession is based on. I know I am biased because I practice in an area with many providers and excellent tertiary hospital systems that are very supportive. The MDs I work with have been great in fostering relationships with the larger hospital in Boston, and I have no problem picking up the phone or shooting an email to an MD at MGH/ tufts/ brigham to advocate for my patients and get them seen asap in Boston when they need to be. The difficult cases I always discuss with the MDs I work with, but they trust me enough to collaborate the transfer to Boston when needed. They also let me manage the complex cases of my patients when I feel like I can with their close supervision. But I have no problem transferring someone to the MDs in my practice when I know I am beyond my scope. I will still follow their charts to learn whatever rare condition we are dealing with.

I would be not see a practitioner MD, NP, or otherwise, who thought they knew everything Or were not aware of their limitations. I appreciate someone saying I do not know, but we will figure this out. My daughter’s pediatrician (who is an MD)has said this to me and I appreciated the honesty.

I think it is a generalization to say most PAs are surgical. I went to PA school in Boston/trained in Boston. Most of the PAs I know work in private practice, in all areas of medicine including internal medicine, OB/gyn, peds, urgent care, ER. Yes there are a lot of PAs in the surgical specialties, but the majority is not.

[cckwmh]

In the US PAs always work off a physician’s license (with their own license requirements) and always need supervision. Doesn’t mean physician needs to be in room. NP have full authority in 20 states and can work independent of physicians and can bill separately.

For the patient there is more a difference between individual practitioners than licensure. It matters more if you are choosing which one to go into as a profession. People still choose PA school, sometimes because that’s more common in the area. Sometimes it’s because they want to avoid that “nursing theory stuff” and be more medically based.

You can also have Nurse Anesthetist or Psych Nurse specialist which has no corresponding PA area. My DD has her meds managed my a psych NP. I find her much more holistic than Psychiatrists we’ve gone to.

This is not true. Some states it is supervision and some it is collaboration. The 2020 medicare regulations, if approved by congress, remove the word supervision from the requirements of practice. The move is to optimal team practice, which makes PAs as independent as NPs. Some states already allow this, but to be reimbursed my medicare, a PA currently needs to bill under a physician. This should change in 2020.

[dogmom]

This is not true. Some states it is supervision and some it is collaboration. The 2020 medicare regulations, if approved my congress, remove the word supervision from the requirements of practice. The move is to optimal team practice, which makes PAs as independent as NPs. Some states already allow this, but to be reimbursed my medicare, a PA currently needs to bill under a physician. This should change in 2020.

I’m sorry, my information was out of date. It was certainly true not that long ago. It looks like there are 6 states that can work independently? I think it’s important for lay people to understand we are discussing two completely different concepts. One is professional that has to do with how closely non-MD practitioner needs to work with an MD as far as legal oversight, licensure, billing, documentation, etc. (please not pick this apart, I’m being very general!). This other is how the relationship actually works in the practice on how the MD works with an PA/NP.

The less education than physicians are true, but it’s important to realize that the level of education has steadily been rising. There are still physical groups that will go one about how some NPs only have a high school education. These are people who went to nursing school then a certificate program very early on and were grandfathered in ages ago. I have a friend who worked for years as a trauma nurse with BSN, went to get Doctorate in Acute Care NP, and now is doing a post-doctorate fellowship in the Vanderbilt system while working in their ICU. I do think that with the current emphasis in holistic care in all of education, both PA and NPs have that experience. In the past they were more surgical focused and where I practice I think the surgical practices tend to use them more, but it depends.