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home : columns : ask the doctors October 19, 2018

1/15/2018 9:29:00 AM
More patients getting preventive care from different providers

DEAR DOCTOR: In the last few years I've noticed that after making an appointment to see a doctor, I'm often seen by a physician's assistant or nurse practitioner instead. What's the difference? When should I insist on being seen by a physician?

DEAR READER: You're correct -- nurse practitioners and physician's assistants are now playing larger roles in preventive health care for many Americans. While they can't replace physicians, what they can do is take on a significant range of duties in primary care. This frees up doctors to manage the big picture of a patient's health care and to spend more time with difficult, complex cases.

Let's start with some definitions.

The difference between a physician, a physician's assistant and a nurse practitioner is in their schooling. Each is a nationally certified and state-licensed medical professional who has successfully completed four years of college as an undergraduate.  

Aspiring physicians go from college to four years of medical school, followed by an additional three to seven years of specialized training as residents. Many then undergo additional training in fellowships, which can last from one to three years.

For physician's assistants, or PAs, college is followed by three years of medical training in an accredited program. More than 2,000 hours are spent in clinical rotations that include family medicine, internal medicine, general surgery, emergency medicine, pediatrics, and obstetrics and gynecology. In order to enter practice, PAs must pass a national certifying exam and qualify for a state license. All PAs are required to work with a supervising physician.

A nurse practitioner, or NP, is a registered nurse whose advanced training allows her or him to perform an expanded range of duties. These include physical exams, diagnosing and treating chronic diseases like diabetes and arthritis, ordering and interpreting diagnostic tests, and prescribing medications. An NP can perform procedures like stitching a wound, setting a break and performing a skin biopsy. Their focus is preventive medicine, wellness and education. Depending on the state, NPs may work independently of a physician's supervision.  

Both PAs and NPs have a role in surgery, but to what extent depends on laws and regulations, which vary greatly from state to state.

Like many of our colleagues, we see a role for PAs and NPs in preventive care, such as well-woman and well-baby exams, geriatric assessments, and in urgent care cases that are not complex or severe. Here at UCLA, many hematologists and oncologists work alongside an NP. The NPs help care for complex cancer patients, coordinating imaging, therapy and routine follow-up visits.

By handling certain parts of a medical visit, like collecting data, compiling a medical history and assessing general health, PAs and NPs free up physicians' time so they can focus on more complex issues.  

This leads us to the second part of your question, which is when to ask to see a physician. We suggest that you make it a practice to ask whether a doctor is available during your appointment. That way, if an exam or test reveals anything troubling or abnormal, if you want a second opinion about something the PA or NP has said or if you have questions that you prefer to have answered by your doctor, then you know he or she is available to you.

(Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health.)

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