MEDICINE

These days, more and more people receive their medical care from allied health personnel that serve as “physician extenders” to deal with a shortage of physicians. This is especially true in primary care specialties. Unfortunately, many patients are confused to see a nurse practitioner or a physician’s assistant for their routine medical needs and come to regard these professionals as their “doctor.”

While it is good they come to trust these individuals, it also adds to the public’s confusion of exactly who is providing their health care. How do physicians differ from, say, nurse practitioners and physician’s assistants? How do these last two differ from each other? What is a licensed practical nurse compared to a registered nurse? Here is a breakdown on some of the differences in education and salary among these various professionals.

Physician

A physician must have a bachelor’s degree from an accredited college or university plus complete four years of education in an accredited allopathic or osteopathic medical school to receive a Medical Doctor (MD) or Doctor of Osteopathy (DO) degree, respectively. Some universities offer a six-year curriculum leading to a combined bachelor’s degree and doctor of medicine degree. Some medical schools compress the full four-year curriculum into three years by eliminating vacation time and some elective clinical rotations.

Once an MD/DO degree is obtained, the physician has to complete a residency in a medical specialty approved by the American Board of Medical Specialties. This can vary from three years for family practice or internal medicine to four years for anesthesiology to seven years for neurosurgery. Salaries vary widely depending on the specialty and type of practice (independent private practice or salaried physician in a hospital or large physician group), but are typically in the low to upper six figures. Physicians have no restrictions in practice within their specialty.

Medical assistant (MA)

An MA must have a high school diploma or GED. There are two pathways but only one leads to certification as an MA. First, the individual may get on-the-job training with a physician. In the other, the individual completes a program accredited by the American Association of Medical Assistants. The course of study is usually about 34 weeks long. Responsibilities of an MA include keeping medical records, taking of patient histories, preparing patient exam rooms and patients, minor procedures (injections, vaccinations, changing dressings), administering medications as prescribed by a physician, and patient education. Median salary nationwide is $30,000 annually.

Licensed Practical Nurse/Licensed Vocational Nurse (LPN/LVN)

You must have a high school diploma or GED, and then attend an accredited vocational school to earn a certificate. The course of study is usually 12-18 months. Responsibilities are more patient-care centered and comprehensive than for an MA— taking patient histories and vital signs, changing dressings, performing minor procedures depending on experience, drawing blood, starting IVs, and assisting physicians with procedures, and they are most often supervised by a registered nurse. This degree can be a first step to becoming a registered nurse. Median salary is around $42,000 annually.

Registered Nurse (RN)

RNs need a high school diploma or GED to follow one of two RN pathways. First is a three-year course of study in an accredited nursing school leading to a licensure as a registered nurse. The other is a four-year program leading to a bachelor’s in nursing science degree. The education is broader and more in depth than for MAs or LPNs/LVNs. Graduates of four-year programs are often preferentially hired in hospitals and advance more easily to supervisory positions. Nurses provide direct patient care and have a wide breadth of responsibilities, including critical care, acute care, and emergency care. There is much flexibility with an RN degree. Median pay nationally is $28 per hour or around $60,000 a year for full-time work. Registered nurses may go on to earn a master’s degree and even a Ph.D. in nursing science.

Nurse Practitioner/Advance Practice Registered Nurse (NP/APRN)

You must have a bachelor’s degree in nursing science, and then pursue a graduate program, typically 1824 months, leading to a master of nursing science degree. Some obtain a Ph.D. (doctorate) in nursing science or in a related health field. This is also a bit confusing to patients because now you have a nurse who is also a doctor but not really a medical doctor. Most programs prefer applicants to have several years of practical experience as a registered nurse before applying. NPs and APRNs may work under a physician but may also practice independently as a primary care provider. Some nurse practitioners specialize in certain areas such as pediatrics or geriatrics. Median salary is $98,000 annually.

Certified Registered Nurse Anesthetist

This is a specialized area of nursing. CRNA’s are registered nurses with a bachelor’s degree in nursing with at least one year’s experience in acute care who then studied for two to three years in an approved program leading to certification as a nurse anesthetist. CRNA’s administer anesthesia under the supervision of an MD/DO anesthesiologist. Median salary is around $170,000.

Certified Anesthesia Assistant (CAA)

These individuals must have a bachelor’s degree in a health care field or nursing. Some medical experience is preferred but not required. Must complete a two-year master’s program leading to certification as a CAA. CAAs function very much like CRNA’s and the salary is comparable.

Physician’s Assistant (PA)

You must have a bachelor’s degree and three years of experience in a health care field. This can be as an emergency medical technician, paramedic, or as a nurse. You then complete a master’s degree in an accredited school, typically two years, leading to certification as a PA. Most PAs then choose an area that interests them and work with a physician in that field to learn the particulars. PAs are very patient centered and always work under the supervision of a physician, but have a great deal of autonomy and may see patients on their own. Median salary is $97.000.

The difference between physicians, nurse practitioners, and physician’s assistants is underscored by the length and breadth of training. A physician family practitioner will typically have four years of college, four years of medical school, and three years of a residency in that specialty. A nurse practitioner or physician’s assistant will have four years of college, some practical experience in health care, and two years of education for their degree. An anesthesiologist, a medical doctor, will typically have four years of college, four years of medical school, and four years of residency training in anesthesia. A nurse anesthetist or anesthesia assistant will have a four-year college degree, some work experience in health care, and complete a twoto three-year program in anesthesia training.

What’s essential here is remembering the amount of training and experience these health care professionals need to do the work they do. All of them are in place to assure patients get the best of care.