Who’s who in your doctor’s office?
You’re sitting in the exam room of your regular doctor’s office, hoping to get some relief from your flu-like symptoms. You’ve been told the physician you usually see is off today, but they’ve juggled the schedule so that someone else can see you. In walks a man in a white coat who introduces himself as “Tim Johnson.” You assume he’s a physician, but is he? How can you tell? What other medical professionals are you likely to encounter in a primary care office?
Contrary to popular belief, the white coat doesn’t automatically denote a physician. Nurses, physician assistants and other health care providers wear it as well. So, how can you tell these different professionals apart? The following should help you understand what they do.
Primary care physicians
Specializing in either family practice or internal medicine, these physicians are trained through four years of medical school and three years of residency. They may hold either a Doctor of Medicine (MD) or a Doctor of Osteopathy (DO), depending on the type of medical school they attended. Family practice physicians can care for everyone, from newborns to the elderly, while internists (physicians specializing in internal medicine) treat only adults. Although internists have traditionally been seen as treating older or sicker people, most healthy adults will be fine seeing either one—if they can get an appointment.
The primary care physician shortage is becoming a major problem as more patients, many with health insurance for the first time, raise the demand for appointments. At the same time, many primary care physicians are retiring and fewer new graduates are taking their places. However, primary care is about more than just doctors, and health care providers in other disciplines are stepping up to fill this void.
These primary care providers work under the supervision of a physician to diagnose and treat most common illnesses. Physician assistants (PAs) typically have a master’s degree. Their education, which is meant to complement that of physicians, consists of classroom and laboratory instruction in the basic medical and behavioral sciences (such as anatomy, pharmacology, pathophysiology, clinical medicine and physical diagnosis), followed by clinical rotations in internal medicine, family medicine, surgery, pediatrics, obstetrics and gynecology, emergency medicine and geriatric medicine.
PAs can perform physical exams, provide a broad range of diagnostic and therapeutic services and write prescriptions, although in some states their supervising physician must sign off on any prescriptions for controlled substances.
Family nurse practitioners
Family nurse practitioners (FNPs) hold registered nurse (RN) and advanced practice nursing licenses with the authority to diagnose, prescribe medications and manage patient care. FNPs address the primary care shortage by providing holistic, patient-centered primary care. “The main difference between family nurse practitioners and physician assistants is the education each received,” said Martha Hare, DNP, RN, FNP and clinical assistant professor at the Texas A&M College of Nursing. “FNPs receive extensive training, based on a nursing model, which focuses on health promotion, disease prevention and care management.”
At a minimum, FNPs have a master’s degree and national board certification as a family nurse practitioner. In some states, FNPs can act as independent practitioners. In Texas, however, they must be supervised by a physician (similar to physician assistants).
Working as a team
Other health care professionals you may encounter in a primary care office include registered nurses (RNs) and licensed vocational nurses.
“All of the members of the primary care team have important roles to play in helping to relieve the primary care shortage and ensure all patients have access to excellent health care,” said Paul Ogden, MD, interim senior vice president & chief operating officer at the Texas A&M University Health Science Center and interim dean of the Texas A&M College of Medicine. “It is important that everyone is empowered to provide care to the full extent of their license and that we utilize all specialties together, as a team, to address the overwhelming shortage of providers.”