MD, PA, NP: sorting the letters of health care providers

These days, there are so many different providers of health care, which one you’re seeing might be a source for confusion.  There are so many different letters involved, sometimes medical business cards are like a tornado of alphabet soup. There are MDs, DOs, FNPs, ACNPs, PA-Cs, and CRNAs. There may be more that I’m forgetting. On top of that, the various training levels doctors go through to become a “real” doctor is also somewhat difficulty for the public to follow. Let’s break it down.

I’ll start with the docs, since that’s the one I’m most familiar with. After 4 years of college and 4 years of medical school, these physicians graduate with a doctorate degree, either Medical Doctor (M.D.) or Doctor of Osteopathy (D.O.). These two types of schools are similar, but the osteopathic school tends to be more holistic, using some manipulative techniques to assist in healing the body.

After medical school, these young doctors go to residency. This is specialty training, and it lasts 3-5 or more years. Yes, even your primary care doctor, or the old term “G.P.” is a specialist these days. While in training, these guys are actually doctors (as soon as they get that M.D. or D.O. degree), but they aren’t ready to take care of patients on their own. Gradually, over the course of their training, they are given more and more responsibility and autonomy. After residency, most of these physicians will go out into practice, and a small number will become subspecialists, which requires a fellowship. During that time, these doctors are no longer called residents. They’re called fellows. Eventually, everyone ends up as an attending physician, the proverbial “real doctor” everyone at teaching hospitals wants to see.

As you engage the health care system, you will also encounter midlevel providers: nurse practitioners (NPs), physician assistants (PAs). In most situations, these people work under the supervision of a physician, but that varies from state to state.  These providers are a great resource, and help make more health care available to more people throughout the country.  Just like doctors, some are great, and some are not so bright, but that’s true everywhere. Most are very intelligent and provide excellent care. I would not hesitate to receive care from a good midlevel provider.

Nurse anesthetists (CRNAs) are nurse practitioners who work in the operating room delivering anesthesia to patients. Again, these folks usually work under the supervision of an anesthesiologist, although this, too, varies by state. The CRNAs are trained in all matters of anesthesia care.

In summary, medicine is a team sport these days. In an attempt to deliver quality but cost-efficient health care, there are an increasingly diverse number of players on that team. Don’t hesitate to ask questions about each person’s role in the care you’re receiving.

What interactions have you had with various or less-traditional providers?

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