Is It Okay if Your Doctor’s Visit Doesn’t Include a Doctor?

Something is bothering you. Maybe it’s a rattling cough that won’t go away, or a new lump that popped up someplace it shouldn’t.

You finally decide to get it looked at, so you make an appointment at your doctor’s office. Thankfully, the receptionist can squeeze you in. But instead of meeting with your good ol’ doc, you’re told you’ll visit with the nurse practitioner (NP) or physician assistant (PA) instead. What gives?

If you’ve made a medical appointment recently, there’s a good chance you didn’t end up seeing a doctor. According to a recent study in the journal Healthcare, 31 percent of all visits in community health centers were with NPs or PAs.

And if you haven’t seen one yet, you will soon: The number of NPs and PAs delivering primary care is expected to increase 30 percent and 58 percent, respectively, from 2010 to 2020, a National Center for Health Workforce Analysis report found. That’s important, because during that same period, we could experience a shortage of more than 20,000 primary care doctors.

“We don’t have enough physicians to meet the growing demand for our patients,” says Rhonda Hoyer, N.P., the director of advanced-practice providers at UW Health at the University of Wisconsin-Madison. “So NPs and PAs are increasingly being called to be another service provider, working side by side with physicians.”

Feel a little iffy about bending over and coughing for someone without an M.D. or D.O. after his or her name? It’s time to get to know your friendly neighborhood NPs and PAs.

What’s the Difference, Anyway?

It’s no surprise that your doctor has gone through a crap-ton of schooling and training: 4 years of undergrad, then 4 years of med school, followed by 3 to 7 years of residency depending on their area of specialization, and finally an optional 1- to 3-year fellowship for more specialized training.

After their 4-year undergrad nursing degrees, NPs go on to complete either a master’s or a doctorate degree-about an additional 2 to 4 years-where they receive more advanced clinical and diagnostic training in their area of specialty. Before their grad degree, most generally work as registered nurses for a period of time.

Most students enter the PA program with a bachelor’s degree and about 3 years of healthcare experience, such as being a medical assistant or an emergency medical technician (EMT). The average PA program is about 26 months long, and in many cases, they share classes and clinical rotations alongside a school’s medical students. They graduate with a master’s degree.

Both PAs and NPs must be nationally certified, as well as licensed in the state in which they will practice. (Laws differ by state). Their scope of practice-or what they’re permitted to do-depends on both state law and their specific place of work.

PAs practice in teams with physicians, under their supervision, and some NPs do, too. In 19 states and Washington, D.C., however, they’re able to practice independently.

But supervision doesn’t mean a doc has to stand over their shoulder. PAs and NPs see patients on their own, and in some offices, they can function as your primary provider. It just means a physician must be available to answer any questions, look over charts, or consult about a patient’s care.

What Do NPs and PAs Do?

Many clinics use a team approach, with doctors, PAs, and NPs working together to help provide the best access and care to their patients. Lots of practices use PAs and NPs to take care of same-day sick visits, where they perform exams, diagnose illnesses, and treat things like colds, rashes, and the flu.

“We often have NPs and PAs more lightly scheduled, so they have availability the same day,” says Yul Ejnes, M.D., immediate past chair of the board of regents of the American College of Physicians. “So if someone strains their back or has a cold that just won’t go away, they can be seen in our office instead of going to urgent care or the emergency room.”

These providers can also drain abscesses, stitch up wounds, and even remove funky-looking moles for biopsy. They often perform physicals or well-visit exams, and take on follow-up for patients with chronic issues, like high blood pressure or diabetes.

In many cases, NPs and PAs may have more time to spend with patients, so they may be better able to teach you what you need to know about your illness and customize care so you can meet your goals.

“I find that my PA and NP colleagues are good at a lot of the education and motivation part of the work,” says Wanda Filer, M.D., president elect of the American Academy of Family Physicians. “I try to do it, too, but time is tight-so it’s teamwork.”

So How Can You Get The Best Care?

You’re not losing out-recent research has shown that the quality of care provided by NPs and PAs is comparable to that of physicians. But there are a few things you should know to make sure your practice is making the most of its providers.

State laws differ on how-or in the case of NPs, if-these providers are supervised. For instance, some states like California, New York, and Pennsylvania cap the number of PAs each physician can supervise. Meanwhile, other states like North Carolina and New Mexico allow doctors to decide how many are needed.

And that’s important: The number of providers each doc supervises can give you a clue about how available he or she is to answer any questions the PAs or NPs may have or provide guidance they may need, says Dr. Ejnes.

“I think knowing how many NPs or PAs a doctor is supervising is a good question to ask the office,” he says. An office of five doctors supervising three PAs or NPs, for instance, might be more reassuring than finding out each doc has six or seven on his plate.

Another good thing to ask, Dr. Ejnes says, is whether there is a physician actually in the office when the other providers are seeing patients. That means the doc would be able to pop into an exam room to take a look at a weird rash or listen to some strange chest noises that might have them stumped. After all, primary care physicians ask specialists for input if they see something that falls outside their own areas of expertise.

“We all have a scope of practice,” says Hoyer. “NPs and PAs know their boundaries, know their limits, and can say ‘I’m not sure what going on here.’ That’s why we work on teams with our physician colleagues-they have the training and education for the high acuity, highly complex, serious medical cases that we don’t necessarily have.”

But When Should You See a Doc?

There’s not really a set list of diseases or symptoms that would require a physician’s expertise. But as Hoyer pointed out, complex cases might be best left to a doctor. That means patients who have a whole lot of things going on-for example, maybe those with an active cancer, on multiple meds, and complaining of new, mysterious symptoms.

Some offices also have protocols in place where people with chronic conditions like heart disease or diabetes will see a physician after a certain number of visits with a PA or NP, says Dr. Filer. That might happen sooner if your condition goes haywire.

“It’s when things seem to be destabilizing, or risk seems to be increasing, that you can move to see a physician more often,” she says.

Also, say you feel lousy, but you can’t really put a finger on why. You might be unable to articulate what’s bothering you-it’s nothing concrete like a stomach pain, a backache, or a cough-but you just don’t feel right.

“A physician might be a better choice in terms of trying to get to the bottom of that,” says Dr. Ejnes.

But it’s important to remember that people who are having a health problem should be seen as soon as they can, says Dr. Filer. So if you’re having any issues that concern you, you don’t want to “hold out” for an opening in the physician’s calendar.

“Any of my NP or PA colleagues can begin the assessment, and if they feel like they need help or need to pull me out of the room, I trust that they are going to do it,” she says.

This article originally published in Men’s Health on January 19, 2015. All credit is given to Christa Sgobba and Men’s Health for this article. In no way does Lucas County Health Center take credit for the information in this article.