Whom Do You Choose-A Nurse Practitioner or a Physician Assistant?

Article excerpt

Psychologists are midlevel providers. So are occupational therapists, nurse midwives, and social workers. But when most group practices think of hiring an MLP, they think of a physician assistant or nurse practitioner to help their harried primary-care doctors.

But which one? In terms of their capabilities, NPs and PAs are more alike than different. But you may gravitate to one or the other depending on your patient population, your doctors, and state laws defining MLPs' purview.

Physician assistants, whose specialty gained impetus from medics returning from the Vietnam War, generally train in twoyear postgraduate programs. Most who work in primary care are generalists in the FP mold. In a typical day, PA Randall Ideker at Group Health Permanente in Lynnwood, Wash., for example, might treat someone with the flu, remove a toenail, splint and cast a simple fracture, counsel a depressed patient, and prescribe a painkiller for someone with a gall-bladder problem.

Nurse practitioners-RNs with advanced education and clinical training-tend not to perform as many procedures or see as many patients as PAs do. Instead, they're more likely to subspecialize in primary-care fields such as pediatrics. NPs place a greater emphasis on patient education, and, in general, reflect a nurse's concern for the whole patient. "Because of my training as a nurse, I don't consider just the physical problem at hand, but what's going on in the home," says pediatric NP Nancy Quigley at Health Key Beacon in St. Louis.

Groups with a track record of using midlevel providers say there's no dramatic difference between PAs and NPs. …