Do you see the doctor or the Physician’s Assistant?

Are there enough primary care doctors in Tucson?  Do you see the doctor or the Physician’s Assistant?  In Arizona, Nurse Practitioners are not required to work under a physician.  Medicare may soon be encouraging the use of Nurse Practitioners (NP) and Physician’s Assistants (PA) in order to save money.

Currently, Medicare’s payment rules require “medical homes” to be led by doctors, meaning NPs and PAs can’t see Medicare patients if they have their own practice. A number of states, like Arizona, allow NPs and PAs to operate on their own. The list includes California, Florida, Georgia, Idaho, Illinois, Kansas, Kentucky, Maine, Missouri, Montana, North Carolina, New York, Oklahoma, Pennsylvania, Tennessee, Vermont, Washington, Wisconsin and West Virginia.

There is a movement in Congress to change the Medicare rules to save money by expanding the role of Nurse Practitioners and Physician Assistants. One bill in the House replaces “physician” with “provider” throughout a section describing payment rules and adds “nurse practitioner and physician assistant” to the definition of “applicable provider.”

It’s good to know our representatives in Washington are working on things that will reduce Medicare costs.  But it’s kind of scary to think of the lobbying that goes on behind the scenes that is working to stop the expansion of the use of Nurse Practitioners and Physician Assistants.

Tucson and the Arizona medical community are ahead of many other parts of the country when it comes to the roles of Nurse Practitioners and Physician Assistants – and Medicare needs to catch up to us.

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9 Responses to "Do you see the doctor or the Physician’s Assistant?"

  1. tiponeill says:

    The AMA is still powerful, and although now everyone blames insurance companies the historical fact is that they are the reason our healthcare is so screwed up.

  2. Ricardo_007 says:

    To mention PAs as if they are the same as NPs is an enormous misunderstanding of the two professions. NPs are masters level trained. PAs have associates degrees.

  3. Denise_Early says:

    PAs do not have associates degrees. Those are 2-year programs. PAs have 4-year college degrees and then enter a post grad program to come a PA. Nurse Practitioners have nursing degrees and then more training.

    Most PA students have a bachelor’s degree and about three years of health care experience before entering a PA program.

    Accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), PA programs are approximately 27 months long and include classroom instruction and clinical rotations.

  4. Ricardo_007 says:

    Nurse Practitioners have Masters degrees in Nursing with certification in practice fields. The scope of practice for a PA is significantly narrower that for NPs. To become a PA, one must not have a Masters degree. NPs have solo practice autonomy from MDs to practice. The same cannot be said for any PA.
    This comment is primarily intended for anyone reading this poorly written article wherein the term NP and PA are used interchangably.

  5. Denise_Early says:

    The article is not about the differences between Physician Assistants and Nurse Practitioners. It is about bills in Congress that would affect payment of services provided by NPs and PAs. I’m just reporting what Congress is doing. Please re-read the following:

    One bill in the House replaces “physician” with “provider” throughout a section describing payment rules and adds “nurse practitioner and physician assistant” to the definition of “applicable provider.”

    You correctly point out that NPs have more medical education than PAs, but that was not the point of the article.

    Many people, myself included, have never seen the doctor who is listed as their primary care physician. They see a PA or NP. Insurance companies and Medicare pay a lot less when a patient sees an NP or PA than when they spend a few minutes with a doctor.

  6. Ricardo_007 says:

    I have been seen by an NP for the past 10 years. For many more careful medical consumers, the difference between how patient care is addressed between the MDs and NP is what makes NPs more appealing to me. My NP is concerned with preventative care by addressing my body, mind and spirit. She does this by spending an hour with me. Interviewing me and asking questions about lifestyle. MDs in my experience are trained to address patient complaints as discrete pheonomena and not as part of the whole. BTW, my NP charges $250/Hr and the value of care I receive is well worth it. My NP does not take health insurance. I love her.

  7. BajaDemocrats says:

    Sounds like your NP is a very good one. As Denise points out, her article is only about a movement in Congress to change the Medicare rules to save money by expanding the role of Nurse Practitioners and Physician Assistants. The article is not about the differences between a NP and PA.

    I saw a NP for several years and also thought she was very good. A few years back her Physician’s office stopped accepting my insurance plan, and I switched to a PA. Fortunately, my current medical needs is primarily preventive care, bi-annual checkups with blood tests, and an annual chest x-ray I insist on – i smoked for many years and I test false positive to the skin test for TB, so a good reason to check all is well in the lungs. I would give my PA slightly higher marks than my former NP for his knowledge and competence. Last fall I noticed a small naval hernia, and my PA insisted I accept his referral to a surgeon to have taken care of before :”it gets any worse”. Turned out to be very good advice – the surgeon said it was caught in time that he could repair it with only stitches instead of having to insert a mesh that he thought might be necessary.

  8. Ricardo_007 says:

    The disitinction between NPs and PAs is not made. The impression is given that NPs & PAs are interchangeable. The lack of distinction can leave a an uninformed medical consumer thinking that the two are interchangeable.

  9. BajaDemocrats says:

    I sure didn’t get that ‘impression’ from reading the article. It would be completely accurate to say ‘Medicare currently covers services provided by either a General Practitioner or a Neurosurgeon’ (“Brain” Surgeon). Does that give the impression they are interchangeable? I don’t think so.

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